Bloody Placentas

No, literally.

There is now quite good evidence of the advantages of delayed cord clamping in the term infant, with most particularly an improvement in iron stores in the baby that has lasting effects during the first year of life. The current recommendation is to hold the baby at the level of the vaginal introitus. But it is also recommended to place the baby directly on the mother’s abdomen, and then to encourage immediate skin to skin contact.

So you can’t do both. Keeping the baby at the level of the vagina is recommended in order to encourage the transfusion of placental blood, but it may not be necessary. Gravity may not be that important, as the forces of uterine contraction can probably easily overcome the weight of a few centimeters of a column of blood.

Nestor Vain and colleagues from Argentina have just published a trial in term delivered mother infant pairs where they randomized to either keeping the baby down low, or lifting the baby onto the mother’s abdomen. They weighed the baby as quickly after birth as possible (usually within 15 seconds), and the again after 2 minutes, which is when the cord was clamped and cut.

In both groups the weight  of the baby increased by about 50g, there were no differences by group assignment, and no apparent effect of the position of the mother’s body. There were about 270 babies in each group, with about 80 exclusions in each group, for quite appropriate reasons (c-section, need for resuscitation, cord around the neck etc).

I congratulate Nestor and his colleagues for this study, I would never have thought of doing this, but it is very useful information for obstetricians everywhere, you can deliver the baby onto the mother’s abdomen and delay clamping the cord for 2 minutes; getting the benefits of both early skin to skin contact and placental transfusion.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged . Bookmark the permalink.

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