A physiologic approach to cord clamping: Clinical issues

  title={A physiologic approach to cord clamping: Clinical issues},
  author={Susan Niermeyer},
  journal={Maternal Health, Neonatology and Perinatology},
  • S. Niermeyer
  • Published 8 September 2015
  • Medicine
  • Maternal Health, Neonatology and Perinatology
BackgroundRecent experimental physiology data and a large, population-based observational study have changed umbilical cord clamping from a strictly time-based construct to a more complex equilibrium involving circulatory changes and the onset of respirations in the newly born infant. However, available evidence is not yet sufficient to optimize the management of umbilical cord clamping.FindingsCurrent guidelines vary in their recommendations and lack advice for clinicians who face practical… 
Clinical aspects of incorporating cord clamping into stabilisation of preterm infants
The current knowledge on how to incorporate cord clamping into stabilisation of preterm infants is reviewed and the physiological-based Cord clamping (PBCC) approach is reviewed, with the infant’s transitional status as key determinant of timing of cords clamping.
A Quasi-Experimental Study to Assess Consequences of Early Versus Delay Umbilical Cord Clamping on Maternal and Neonatal Outcomes in Beni-Suef city
Nowadays, the timing of umbilical cord is considering а growing area of research. The researchers looking for optimize maternal & neonate outcomes. The early umbilical camping is determined as the
Delayed cord clamping in preterm infants: is it time to become standard practice?
A large number of neonates born withfetal hemolytic disease, hydrops fetalis, twin–twin transfusion, genetic syndromes, and potentially lethal malformations were excluded from this randomized controlled trial.
Delayed cord clamping is associated with improved dynamic cerebral autoregulation and decreased incidence of intraventricular hemorrhage in preterm infants.
It is demonstrated that DCC is associated with improved dynamic cerebral autoregulatory function and may be the mechanism behind the decreased incidence of IVH.
Factors associated with umbilical cord clamping in term newborns.
The identification of associated factors and the comparison between recording and observing the clamping time can help in the planning and implementation of improvements for adherence to good practices at birth.
Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates.
Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis.
Delivery room care and neonatal resuscitation while on intact placental circulation: an open-label, single-arm study
Delivery room care and neonatal RIPC is feasible and safe across gestations and system Usability Score rated >68 (good) in 90% and 52–68 (fair) in 10%.
Umbilical Cord Practices of Members of the American College of Nurse-Midwives.
There has been an increase in the practice of delayed cord clamping over the last 20 years, but cord milking is not as widely practiced as DCC, and respondents were less likely to be convinced by the evidence for Cord milking.
Golden 60 minutes of newborn’s life: Part 2: Term neonate
  • D. Sharma, Pradeep Sharma, Sweta Shastri
  • Medicine
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
  • 2017
This part of review will cover all the golden hour interventions in term neonate with current evidence.
Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres.


Timing of Umbilical Cord Clamping After Birth
  • Medicine
  • 2013
Evidence exists to support delayed umbilical cord clamping in preterm infants, when feasible, and the possibility for a nearly 50% reduction in intraventricular hemorrhage, however, currently, evidence is insufficient to confirm or refute the potential for benefits from delayed Umbilical Cord Clamping in term infants, especially in settings with rich resources.
Ventilation before Umbilical Cord Clamping Improves the Physiological Transition at Birth
There is an urgent need for the development of management strategies that facilitate this transition to newborn life, which will likely include improved strategies for the management of the maternal third stage of labor.
Optimal timing of umbilical cord clamping for term and preterm babies.
Rethinking Placental Transfusion and Cord Clamping Issues
A brief delay in clamping the umbilical cord results in a placental transfusion that supplies the infant with a major source of iron during the first few months of life. Cord circulation continues
Steps for implementing delayed cord clamping in a hospital setting
Healthcare providers interested in implementing DCC in a hospital setting may benefit from a procedural practice plan that includes an assessment of organizational readiness to adopt a DCC protocol, methods to measure and encourage staff compliance, and ways to track outcome data of infants who underwent DCC.
Immediate versus delayed umbilical cord clamping in premature neonates born < 35 weeks: a prospective, randomized, controlled study.
DCC seems to be safe and may be beneficial when compared with ICC in premature neonates, however, the differences between the two methods were modest and the clinical relevance needs to be assessed further by larger studies and additional meta-analysis of randomized trials.
Hemodynamic Effects of Delayed Cord Clamping in Premature Infants
DCC in premature infants is associated with potentially beneficial hemodynamic changes over the first days of life, and resulted in significantly higher superior vena cava blood flow over the study period.
Placental transfusion strategies in extremely preterm infants: the next piece of the puzzle.
The review provided herein suggests that delayed cord clamping or umbilical cord milking can be applied safely to infants born prior to 28 weeks gestation, but the lack of evidence on the best practice among infants born severely depressed and requiring immediate resuscitation is recognized.
Immediate and Delayed Cord Clamping in Infants Born Between 24 and 32 Weeks: A Pilot Randomized Controlled Trial
The immediate benefit of improved blood pressure was confirmed and other findings deserve consideration for further study.
Delayed cord clamping and blood flow in the superior vena cava in preterm infants: an observational study
Blood flow in the SVC was higher in infants where delayed Cord clamping was performed, and the relationship of IVH, low flow and timing of cord clamping requires further study.