The Apgar score
Apgar (1953) devised her scoring system for  the
newborn at the Sloane Hospital (Columbia
University) in New York [1].  Scoring began 1 minute
after birth, because this was the time of most severe
depression in infants who did not breathe right away
at birth.  At the Sloane Hospital the cord was always
clamped and cut immediately after birth, for transfer
of the infant out of the "sterile field" and into the care
of neonatologists.  The assumption was that
transition from placental to pulmonary respiration
should take place within seconds following birth.

Apgar et al. (1958) pointed out that many
obstetricians at that time still practiced "slow
delivery," waiting for pulsations of the cord to cease,
and even suggested that a score could still be
assigned, obtaining the heart-rate of the infant by
palpating the umbilical cord.

Research on the benefits of continuing  
placental circulation after birth
Meanwhile, research did not stop on the benefits
and greater safety of allowing placental circulation to
continue following birth [3-8].

Placental transfusion following cesarean birth
Landau et al. (1950) were among those who
practiced "slow birth," except for babies delivered by
cesarean section [2].  On the basis of their own
experience, and a careful review of the literature,
they developed a technique of maintaining the infant
attached to the placenta until pulsations of the
umbilical cord ceased, with the placenta hung on a
rack above the level of the baby.

Measurements of placental blood transfer
Gunther (1957) measured neonatal weight gain of
infants with umbilical cord left intact until and after
pulsations in it ceased [6].  Like Landau (1950) she
carefully reviewed and compared her findings with
earlier similar research.

Thoroughbred foals delivered with human
assistance
Mahaffey and Rossdale (1957, 1959) reported a
convulsive syndrome of thorough bred foals
delivered with human assistance [7, 8].  They
expressed concern that the syndrome resulted from
early severance of the umbilical cord resulting in up
to 25% of a foal's normal blood volume.  Mahaffey
and Rossdale pointed out that this syndrome does
not occur in foals born unattended.

Pulsation of the umbilical cord stump
Desmond et al. (1959) reported on observations of
newborn infants with continuing pulsation of the
umbilical cord stump, which they could relate to
infants suffering respiratory distress [9].  This would
appear to provide evidence of incomplete transition
to postnatal circulation with the ductus arteriosus
and possibly the foramen ovale not fully closed.

Opening of the alveoli
Resuscitation is usually based on ventilation, but for
ventilation to work, the alveoli must be open with
surrounding capillaries filled with blood ready to give
up carbon dioxide in exchange for oxygen.  Thus at
birth, blood must fill the capillaries around the alveoli
before gas exchange can begin.  Jäykkä (1954,
1958) demonstrated that fluid injected through the
pulmonary artery will fill the capillary bed around the
alveoli, with subsequent opening of the alveoli
evenly throughout the lungs whereas air leads only
to patchy inflation of the alveoli [10 11].

Remnants of fetal circulation
Jäykkä (1971) later suggested that sudden infant
death during the first year of life might in some cases
be explained by persitent fetal pathways for
circulation re-opening under stress.  He used India
ink to visualize pulmonary circulation in an
8-month-old case of unexpected death; the ink did
not go into the lungs, but instead into a fetal
"precapillary bypass" system of artereovenous
anastomoses which normally become obliterated
during early childhood.  He suggested that a
stressor like upper-respiratory-tract infection might
cause this system to re-open.  This is reminiscent of
the respiratory distress observed by Desmond et al.
in infants with pulsating umbilical stumps attempting
to access the amputated placenta.

Merkle and Gilkeson (2005) have discovered
remnants of fetal circulation using high resolution
imaging [13].  Some of their patients were in their
70s, thus born in the 1930s when umbilical cord
clamping and banking of umbilical cord blood were
rapidly gaining favor.
References
  1. Apgar V (1953) A proposal
    for a new method of
    evaluation of the newborn
    infant.
  2. Apgar V et al. (1958)
    Evaluation of the newborn
    infant – second report.
  3. Landau DB et al. (1950)
    Death of cesarean infants: a
    theory as to its cause and a
    method of prevention.
  4. Siddall RS et al. (1952)
    Effect on cesarean section
    babies of stripping or
    milking of the umbilical
    cords.
  5. Colozzi AE (1954) Clamping
    of the umbilical cord; its
    effect on the placental
    transfusion.
  6. Gunther M (1957) The
    transfer of blood between
    baby and placenta in the
    minutes after birth.
  7. Mahaffey LW, Rossdale PD
    (1957) On the newborn
    infant's oxygen supply.
  8. Mahaffey LW, Rossdale PD
    (1959) A convulsive
    syndrome in newborn foals
    resembling pulmonary
    syndrome in the newborn
    infant.
  9. Desmond MM et al. (1959)
    The phases of "transitional
    distress"occurring in
    neonates in association with
    prolonged postnatal
    umbilical cord pulsations.
  10. Jäykkä S (1954) A new
    theory concerning the
    mechanism of the initiation
    of respiration in the
    newborn; a preliminary
    report.
  11. Jäykkä S (1958) Capillary
    erection and the structural
    appearance of fetal and
    neonatal lungs.
  12. Jäykkä S (1971) Precapillary
    bypass and sudden infant
    death.
  13. Merkle EM, Gilkeson RC
    (2005). Remnants of fetal
    circulation: appearance on
    MDCT in adults.
Full References
top
  1. Apgar V (1953) A proposal for a new method of evaluation of the newborn
    infant. Current Researches in Anesthesia and Analgesia 32:260-267.
    Online at: http://apgar.net/virginia/Apgar_Paper.html
  2. Apgar V, Holaday DA, James LS, Weisbrot IM. Evaluation of the newborn
    infant – second report. JAMA 1958; 168(15):1985-9.
  3. Landau DB, Goodrich HB, Francka WF, Burns FR (1950) Death of
    cesarean infants: a theory as to its cause and a method of prevention.  
    Journal of Pediatrics 36:421-426.
  4. Siddall RS, Crissey RR, Knapp WL. Effect on cesarean section babies of
    stripping or milking of the umbilical cords. Am J Obstet Gynecol. 1952 May;
    63(5):1059-64.
  5. Colozzi AE (1954) Clamping of the umbilical cord; its effect on the placental
    transfusion. N Engl J Med. 1954 Apr 15;250(15):629-32
  6. Gunther M (1957) The transfer of blood between baby and placenta in the
    minutes after birth. Lancet. 1957 Jun 22;272(6982):1277-80.
  7. Mahaffey LW, Rossdale PD (1957) On the newborn infant's oxygen supply.
    Lancet  1957 Jul 13, ii:95.
  8. Mahaffey LW, Rossdale PD (1959) A convulsive syndrome in newborn
    foals resembling pulmonary syndrome in the newborn infant. Lancet. 1959
    Jun 13;1(7085):1223-5.
  9. Desmond MM, Kay JL, Megarity AL (1959) The phases of "transitional
    distress"occurring in neonates in association with prolonged postnatal
    umbilical cordpulsations. Journal of Pediatrics 55:131-151.
  10. Jäykkä S. A new theory concerning the mechanism of the initiation of
    respiration in the newborn; a preliminary report. Acta Paediatr. 1954 Sep;
    43(5):399-410.
  11. Jäykkä S. Capillary erection and the structural appearance of fetal and
    neonatal lungs. Acta Paediatr. 1958 Sep;47(5):484-500.
  12. Jäykkä S. Precapillary bypass and sudden infant death. Lancet. 1971 Dec
    11;2(7737):1315.
  13. Merkle EM, Gilkeson RC. Remnants of fetal circulation: appearance on
    MDCT in adults. AJR Am J Roentgenol. 2005 Aug;185(2):541-9.