Placental transfusion in APH

[Guest Mekado]

Dear colleagues,

Does anyone have a research paper or on article about placental tanfusion in Antepartum hemorrhage ?

Thaks in advance 

[Stefan Johansson]

Is this something you are looking for: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653511/ 

[Guest Mekado]

Thank you very much for your reply.

This article is about fetomaternal transfusion but what I want is applying placental transfusion i.e. delayed cord clamping in such cases or cases like placental abruption

[AlexScrivens]

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.

[Nathan Sundgren]

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.