More on blood volume increase with delayed
ligation of the umbilical cord
Ballentine's 1947 paper reports investigation of the
effects of delaying ligation of the cord on weight gain
as a measure of placental transfusion.
Experimental groups were: 30 infants subjected to
cord ligation after being placed onto scales at the
time of delivery, 30 infants weighed at time of delivery
and again after the cord had stopped pulsating, and
30 infants weighed at delivery and following
transfusion from the placenta placed in a rack as high
as the length of the cord would allow.
In the second group, pulsations in the cord continued
for seven to thirty minutes (average 21.7 mins). In
the group with delivered placenta above the infant,
pulsations continued for 12 to 30 minutes (average
23.8 mins). Elevation of the placenta did not increase
weight gain. This indicates that postnatal placental
transfusion is controlled by the infant's need for
continuing fetal circulation, until full transition to
pulmonary respiration has been established.
Blood volume increased from 37 to 187 cc (average
96cc) in the second group, and from 53 to 125 cc
(average 87cc) in the group with elevated placenta.
Ballentine also reported that 55 percent of the blood
flowed into the infant from the placenta in the first
minute and 84 percent in the first five minutes -- the
two time points that Apgar would within the next five
years chose for evaluating a newborn infant's
condition.
Intravenous ergotrate was used to shorten the third
stage of labor, which provided the group with elevated
placenta.
Balentine wrote that 135 cases were studied, with
equal numbers of primi- and multiparous women, and
only vertex presentations. Nembutal in small doses
was used as premedication. Inhalation anesthesia
was used at time of delivery. All mothers were given
intravenous ergotrate wtih delivery of the anterior
shoulder to shorten the third stage of labor, and
which was noted to result in prompt delivery of the
placenta. One infant was delivered by cesarean
section, and episiotomies were performed in
approximately 75 percent of cases.
Ballentine commented that transfusion as a means of
combating shock may be accomplished by
postponement of severance of the cord, and added:
"Such a measure is of desirable therapeutic
value for infants manifesting vary degrees of
shock as a result of birth trauma following difficult
labor or delivery." [1, p726]
This paper was presented at a meeting of the Medical
Society of the State of Pennsylvania, October 8,
1946. Comments of one discussant, Josiah R.
Eisaman Jr, were included in the published article,
who offered the opinion that among some
obstetricians:
"There seems to be undue haste in severing the
umbilical cord immediately after the second stage
of labor...
...This practice involve many poorly understood
changes in neonatal physiology, i.e., closure of
the ductus arteriosus and ductus venosus...
...Not long ago placental blood was
recommended for transfusions. The volume so
obained was 125 to 250cc, providing immediate
ligation of the cord was performed." [1, p728].
- Ballentine GN. Delayed ligation of the umbilical cord. The Pennsylvania
Medical Journal 1947,Apr;50 (7):726-728.
- Ballentine GN (1947) Delayed
ligation of the umbilical cord.
The Pennsylvania Medical
Journal 1947,Apr;50 (7):726-
728.