Delayed Cord Clamping

[Mohan]

Is there any point in delaying clamping the cord after the placenta has been delivered which sometimes happens before 3 minutes, the time recommended for term babies in the webnar

Also neither AAP nor WHO or Gynecological societies mention 3 minutes as the recommended time as yet. So can there be medico legal issues

[satyen75]

When placenta is delivered then also the blood in placenta can be transferred into the babies so it should  be continued.

Although not recommended. the only medicolegal issue can be if the baby was needing resuscitation and DCC was continued so always see and document that in the notes.

[Mohan]

Thanks satyen for clarifying

 

[Rianne Rotink]

Dear Mohan, from all studies by the team of Professor Stuart Hooper and Professor Arjan te Pas, we know that aeration of the lungs is the master switch to transistion a baby from placental circulation to autonomous circulation. As long as the placenta is not delivered, there is gas exchange and the newborn receives oxygen-rich blood via the placenta. It is therefore important that the baby aerates its lungs before cutting off placental circulation - to ensure that baby's heart receives sufficient oxygen rich blood from the placenta during transition. When the placenta has been delivered, there will no longer be any gas exchange, but there still may be a possibility for placental transfusion, which has some benefit to increase blood volume. This is a nice article on this topic: https://www.frontiersin.org/articles/10.3389/fped.2019.00405/full 

[Mohan]

Dear Rianne,

Thanks a lot for the interesting insight into DCC and the referenced article. I do agree the placental blood volume will be helpful to the neonate. But how will blood flow into the neonate after the placenta has been delivered? One study suggested that the placenta be collected in a sterile bag(if delivered before 3 minutes) and taken along with the baby. If so where will the placenta be kept? On the same matress as the baby or should it be suspended at a higher level for gravity to allow the placental blood to flow into the neonate? Any studies on this and the practical methods of doing this?

Mohan

 

[Mohan]

Any insights into my questions. At least let us know the practice you all are following

[Stefan Johansson]

Check this classical paper out: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60197-5/fulltext

It does not refer to your actual scenario but Maybe findings can be extrapolated

[Mohan]

Thanks