I am not aware of any research on this specific subset receiving DCC. I think the problem is well put by Alex Scrivens above. If the placenta is detached from the uterus and oxygen supply is gone, we cannot leave an asphyxiated baby for 60 seconds with no resuscitation effort. Might they still benefit from the volume transfusion from the placenta? Maybe, but then our only option is to be scrubbed in with the OBs and resuscitate on the intact/ open cord. The data for this is intriguing, but I am not sure it is ready for wide spread adoption.
The other situation is where there was an abruption scare but the baby comes out and looks vigorous. I try to do DCC in these cases, but often everyone was so convinced the baby would be depressed that old habits kick in and the cord gets clamped quickly and the baby passed off to our neo team. It is a work in progress here.
Anecdotally, I had a baby once getting DCC that was very vigorous and doing well. As the OB clamped the cord after 60 seconds the placenta was delivered. We must have beecome detached at some point during the DCC, but the baby did great.
Thanks for the pictures! I’ve seen the bottom picture before and that is the only picture of ”ectropion uveae” that looks similar to my findings, although a very mild variant.
Mostly it looks like the upper pictures although not that extreme and not extending radially outwards onto the iris but only inwards, into the pupil.
Great to bump this topic!
I made a screen shot of the photo you referred to (below), did those infants have such marked "out-stamped areas" at the iris margin?
I also looked into the first suggestion Ectropion uvae, and found something that seemed to look like your first drawing.
Which one best illustrates your clinical finding?
My logic suggests that if the placenta has separated for a period of time or baby has bled into the mother, then DCC may be of limited benefit... (but happy to be proved wrong!)
I think the practical difficulty is that we do a lot of sections for 'suspected abruption', where baby comes out ok, in which case I usually do DCC unless baby looks really grim (scientific term) at birth.
Bumping this one... a very benign condition but for those interested
Had antoher patient with these findings and I did som more digging on the topic....
It looks like it could be "Iris Flocculus/flocculi"
I teamed up with the opthalmologist today to see that they would see what I saw and she did. They usually call it "epithelial cyst of the iris" and if it´s only on the margin of the pupil they dont check it further. If it´s bigger (like this one covering a third of the caudal part of the pupil) they have follow up checks.
There are two Pictures showing iris flocculi in the link below
In Figure 2 - A and B
I also found an old article from 1998 where they describe the phenomenon "Flocculus neonatorum" - a self resolving benign nodular flocculus of the Iris in the newborn.
https://journals.sagepub.com/doi/abs/10.1177/000992289803700509?journalCode=cpja and they estimate it to be as common as 1 out of 30 newborns so I´m surprised that so few examiners recognise these findings
Finally I can sleep peacefully