Updated: Feb 17
One of the many questions hitting our inbox recently is to do with the practice of delayed cord clamping at caesarean section.
As we move practice further towards the stabilisation and resuscitation of the neonate with an intact umbilical cord, one of the very first issues to be addressed is the lack of or minimal timing of delayed cord clamping in theatre.
We recognise that practice is always going to be slow to change. While we wait for practitioner enrolment and trusts to purchase specialist equipment to enable motherside stabilisation, particularly in theatre, we can't ignore that many babies may, in the meantime, be denied adequate time for placental transfusion.
The reason for concern
We know the timing of the clamping and cutting of the umbilical cord has a significant impact on the infant's blood and red cell volume and early iron stores (Erickson-Owens, Mercer and Oh, 2011). This later improving neurological development, white matter gain and fine motor skills (Mercer et al., 2018; Andersson et al., 2011).
The physiology tells us, in utero, at term gestation, one-third of the fetus's blood volume is in the placenta at any one time. At the time of birth, a major shift occurs in the cardiac output to the lungs—changing from 8 to 10% in fetal life to 50% in neonatal life. This shift requires a rapid increase of blood volume to fill the capillary beds surrounding each alveolus to assist with lung tissue recruitment and expansion (Mercer and Skovgaard, 2002).
Receiving placental blood volume ensures a smoother transition and helps to minimise any hypoxic oxidative stress to the neonate.
The issues at caesarean
Maternal post partum haemorrage (PPH)
Kuo et al., (2017) found no clinically significant differenc