Some PubMed abstracts, 1990s

[No authors listed]
Oxford Midwives Research Group.

"A randomised controlled trial of 554 women was
carried out to compare the effects of late and early
umbilical cord clamping on the time of cord
separation. In addition data were collected on
maternal and neonatal outcomes. There were no
significant differences between the two groups in the
duration of cord adherence and neonatal and
maternal outcomes. There appeared to be a higher
rate of jaundice in the late clamped group which did
not reach statistical significance. There was an
unexpectedly higher rate of breast feeding at home
in the late clamped group which did reach statistical
significance. Overall the trial provides no clear
evidence for the benefit of early cord clamping (the
current policy as part of the active management of
the third stage in the UK) on the outcomes
considered." [1, PubMed abstract]


Jona JZ.
Department of Surgery, Medical College of
Wisconsin Milwaukee, USA.

"Six neonates with hernia of the umbilical cord (HUC)
and associated patent omphalomesenteric duct
(POMD) were treated in our hospital in a 10-year
period and are reported in order to emphasize the
potential hazard of clamping the bowel at the time of
the handling of the umbilicus. Any unusual
thickening of the base of the cord along with even
the most minute fistula opening to its side should
alert the physician to the existence of these
combined anomalies. The cord in such patients must
be clamped a safe distance away and early pediatric
surgical consultation must be contemplated.
Obstetricians, pediatricians, and nurses who
customarily clamp, manipulate, or shorten the cord in
the delivery room or upon arrival in the nursery
should be aware of this not-so-rare combination of
anomalies of the umbilical cord and the intestines."
[2, PubMed abstract]


Geethanath RM, Ramji S, Thirupuram S, Rao YN.
Department of Pediatrics, Maulana Azad Medical
College, New Delhi.

"OBJECTIVE: To determine the effect of timing of
cord clamping on iron stores of term infants at 3
months of age. DESIGN: Prospective randomized
clinical trial. SETTING: Tertiary hospital. SUBJECTS:
107 term neonates born to mothers with
uncomplicated pregnancies and with hemoglobin
more than 10 g/dl. METHODS: The 107 infants were
randomized to either early (n = 48) or late (n = 59)
clamping groups at the time of delivery. Outcome
measures evaluated were serum ferritin and
hemoglobin in the infant at 3 months age. RESULTS:
The groups were comparable for maternal age,
parity, weight, supplemental iron intake in
pregnancy, infant's birth weight, gestation and sex.
Maternal and cord ferritin and hemoglobin values at
birth were comparable. The infant ferritin at 3
months were also similar. CONCLUSIONS: Iron
stores at 3 months in term infants are not influenced
by timing of cord clamping at birth." [3, PubMed
abstract]


McDonnell M, Henderson-Smart DJ.
Department of Neonatal Medicine, King George V
Hospital, University of Sydney, New South Wales,
Australia.

"OBJECTIVES: To assess: (i) the size of placental
transfusion following a 30 s delay in cord clamping
following vaginal and Caesarean births; and (ii) the
feasibility of delaying cord clamping in the labour
ward and particularly in the operating theatre.
METHODS: Fourty-six infants born at 26-33 weeks
gestation were randomized to having the umbilical
cord clamped either immediately or 30 s after birth.
The venous haematocrit was measured at 1 and at 4
h of age. RESULTS: There were trends towards
higher mean haematocrits in the infants following
delayed clamping, but these were not significant
either at 1 h (55 +/- 7.7 vs 52.9 +/- 7) or at 4 h of
age (55 +/- 7 vs 52.5 +/- 7). The trends were more
marked in the infants born by Caesarean section,
and in those born at 26-29 weeks gestation.
CONCLUSIONS: A 30 s delay in cord clamping is
feasible at both vaginal and Caesarean births, but
does not lead to the predicted difference in infant
haematocrit. Although physiological studies suggest
that a placental transfusion of 15-20 mL/kg occurs
within 30 s of delivery, these data suggest that future
trials should either delay cord clamping for more
than 30 s, or should alter the position of the infant in
relation to the uterus in order to facilitate the
transfusion. Delayed cord clamping is feasible at
Caesarean section." [4, PubMed abstract]


Papagno L.
Complejo Médico Policial Churruca Visca, Buenos
Aires, Argentina.

"Here we described a critical analysis of the
neonatological procedure of early cord clamping,
meaning this, within 40 seconds after birth. Fifty
three cases are here analysed, in which this practice
was not performed, but instead a late umbilical cord
clamping was done after birth or after the cord had
stopped beating. Variations in hematocrito values
within 24 to 36 hours after birth were studied. A
transitory polycithemia, with a maximum peak 12
hours post-delivery was observed. These values
returned to normal levels between 24 and 36 hours
after birth. K vitamin was not administered to any of
the newborns. No pathology appeared related to this
transitory polycithemia. In can be concluded that the
late umbilical cord clamping represents no risk to the
new-born and that the pathological phenomena
described under these circumstances may be
attributed to the increase in K vitamin dependent
coagulation factors that are induced by the routinary
administration of phitonadione to all normal
newborns." [5, PubMed abstract]


Huang CJ, Jawan B, Poon YY, Lee JH.
Department of Anesthesiology, Chang Gung
Memorial Hospital, Kaohsiung Medical Center,
Taipei, Taiwan, R.O.C.

"A 24-year-old gravida 2, para 1 woman at 38th
week gestation was scheduled for elective Cesarean
section (C/S) because of a previous C/S and
prenatal diagnosis of congenital diaphragmatic
hernia. We decided to intubate the newborn during
delivery before the umbilical cord was cut. After
delivery of the fetal head and part of the shoulders,
the mouth of the fetus was cleared and the trachea
was intubated orally with a 2.5 mm internal diameter
(I.D.) endotracheal tube under sterile conditions
while the uteroplacental circulation was still intact.
The patient had to be repeatedly resuscitated due to
bradycardia in intensive care unit. No surgical
correction of the hernia was attempted because of
the poor condition of the baby, which died 3.5 hours
after birth. Although our case ended up in mortality
despite successful perinatal intubation, we
recommend that in case where airway or ventilatory
problems are anticipated, tracheal intubation is done
during delivery before the umbilical cord is clamped.
When the fetus is sharing the maternal circulation, it
will allow physicians to have more time and safety to
perform corrective measures." [6, PubMed abstract]

(in progress)
References
  1. [No authors listed] (1991) A
    study of the relationship
    between the delivery to cord
    clamping interval and the
    time of cord separation.
  2. Jona JZ (1996) Congenital
    hernia of the cord and
    associated patent
    omphalomesenteric duct: a
    frequent neonatal problem?
  3. Geethanath RM et al. (1997)
    Effect of timing of cord
    clamping on the iron status
    of infants at 3 months.
  4. McDonnell M, Henderson-
    Smart DJ (1997) Delayed
    umbilical cord clamping in
    preterm infants: a feasibility
    study.
  5. Papagno L (1998) Umbilical
    cord clamping. An analysis
    of a usual neonatological
    conduct.
  6. Huang CJ et al. (1999)
    Intubation of newborn during
    delivery with intact umbilical
    cord--a case report.
Full References
  1. [No authors listed] A study of the relationship between the delivery to cord
    clamping interval and the time of cord separation. Oxford Midwives
    Research Group. Midwifery. 1991 Dec;7(4):167-76.
  2. Jona JZ. Congenital hernia of the cord and associated patent
    omphalomesenteric duct: a frequent neonatal problem? Am J Perinatol.
    1996 May;13(4):223-6.
  3. Geethanath RM, Ramji S, Thirupuram S, Rao YN. Effect of timing of cord
    clamping on the iron status of infants at 3 months. Indian Pediatr. 1997
    Feb;34(2):103-6.
  4. McDonnell M, Henderson-Smart DJ. Delayed umbilical cord clamping in
    preterm infants: a feasibility study. J Paediatr Child Health. 1997 Aug;33(4):
    308-10.
  5. Papagno L. Umbilical cord clamping. An analysis of a usual neonatological
    conduct. Acta Physiol Pharmacol Ther Latinoam. 1998;48(4):224-7.
  6. Huang CJ, Jawan B, Poon YY, Lee JH. Intubation of newborn during
    delivery with intact umbilical cord--a case report. Acta Anaesthesiol Sin.
    1999 Jun;37(2):97-100.
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