Pulsation of the umbilical cord stump and
respiratory distress
Desmond et al. (1959) investigated stages of
postnatal recovery in infants with a history of fetal
distress. For their study they selected infants in the
newborn nursery who displayed pulsation of the
umbilical cord stump, because:
"More recent experience with distressed
infants revealed that certain of these
infants show disturbances in the closure
of umbilical vessels after birth." [1, p131]
Landau et al. (1950), less than a decade earlier, had
described the problem with cesarean delivery to be
the immediate clamping and cutting of the cord,
which they addressed by hanging the placenta in a
towel above the infant, and waiting for pulsations in
the cord to cease -- a procedure that involved six to
ten minutes [2].
Desmond et al. in the introduction to their study
continued:
"The umbilical arteries normally
cease to pulsate within a short period
after the infant has been delivered." [1, p131]
They cited 30 minutes reported by Haselhorst and
Allmeling (1929) as the upper limit for pulsations of
the cord to continue, and citing Windle (1941),
Barclay et al. (1945) and Rachmanov (1914) [3-6]
commented:
"While ligation of the umbilical cord
immediately after birth is a tradition
in modern obstetrics, the danger of
hemorrhage from cords left unligated
is not great" [1, p131]
Desmond et al. waited far longer than 30 minutes:
"Forty-one infants manifested prolonged
pulsation of the cord after delivery.
The mean duration of cord
pulsation was 5 hours, with a range
of from 40 minutes to 13 hours after
birth." [1, p132]
Desmond et al. used Apgar's scoring system. Of the
41 infants followed, 21 (51%) had Apgar scores of 5
or less during the first one to two minutes after birth.
Three of the infants appeared to recover, 8 had
transient difficulites, and 30 had persistent problems.
Five infants died during the first 11 hours of life.
Two additional infants later succumbed to infections.
Persistent problems included cardiopulmonary
difficulties in 17 infants, clearcut neurological
problems in 6, and umbilical hemorrhage in 3.
Desmond et al. concluded that pulsation of the
umbilical cord stump in the newborn period is
associated with difficulty in transition from
intrauterine to extrauterine life. They reported:
"Seventy-three per cent of the
infants had either fetal distress prior
to delivery or difficulty with the onset
of respiration on delivery.", [1, p145]
According to Desmond et al., the depression at birth
resulted from a poor intrauterine environment, and:
"Upon delivery, the infant was separated
from further adverse intrauterine influences
and his immediate neonatal problem
became one of recovery as well as of
transition." [1, p141]
However, these infants were born alive. How poor
could the intrauterine environment have been?
Before separation from the mother at delivery,
oxygen was being delivered from the placenta. The
continuing pulsation of the umbilical stump, for hours
after birth, indicates persistence of fetal circulation,
through shunts in the heart continuing to divert
blood flow away from the lungs and attempting to
signal the amputated placenta for ongoing support.
What is the signal, and where does it come from,
that closes the foramen ovale and ductus
arteriosus? Until this is understood, can we presume
to be able to aid recovery of a newborn in
respiratory distress? The signal may well be the
volume of blood needed to fill the capillaries around
the alveoli. Recovery in the newborn nursery often
depends upon giving the distressed infant blood
transfusions or blood volume expanders [7].
As recently as 1986, Beischer and MacKay, in their
textbook of obstetrics, described the significance of
continuing pulsation of the umbilical arteries. By
then immediate clamping of the cord at birth was
more common than in 1959:
"Q: What is the significance of continued
pulsation of the arteries in the umbilical cord at
birth?
A: It means that respiration has not
commenced. The physiological stimulus
causing closure of umbilical arteries (and
ductus arteriosus) is an increase in oxygen
saturation of the blood which occurs when
the lungs expand with air." [8, p 710]
- 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.
- Landau DB, Goodrich HB, Francka WF, Burns FR (1950) Death
ofcesarean infants: a theory as to its cause and a method of prevention.
Journal of Pediatrics 36:421-426.
- Windle WF. Round table discussion on anemias of infancy (from the
proceedings of the tenth annual meeting of the American Academy of
Pediatrics) Journal of Pediatrics 1941 Apr; 18(4):538-547.
- Barclay AE., Franklin K J, Pritchard M L. The Foetal Circulation and
Cardiovascular System, and the Changes That They Undergo at Birth,
Springfield, 1945, Charles C Thomas, pp. 245-248.
- Haselhorst G, Allmeling A. Die Gewichtszunahme von Neugeborenen
infolge postnataler Transfusion. Zeitrschr f. Geburtshulfe u. Gynakologie
1930; 98:103-4.
- Rachmanow AN. Methode der Nichtunterbindung der Nabelshnur.
Ausgefuhrt bei 10,000 Geburten in der Stadtischen Gebaranstalt.
- Murray NA, Roberts IAG. Neonatal transfusion practice Arch. Dis. Child.
Fetal Neonatal Ed. 2004; 89: F101-F107
- Beischer NA, MacKay EV (1986) Obstetrics and the Newborn: An illustrated
textbook, Second Edition. WB Saunders Company, Philadelphia, 1986.
- Desmond MM et al. (1959)
The phases of "transitional
distress"occurring in
neonates in association with
prolonged postnatal umbilical
cordpulsations.
- Landau DB et al. (1950)
Death of cesarean infants: a
theory as to its cause and a
method of prevention.
- Windle WF (1941). Round
table discussion on anemias
of infancy.
- Barclay AE et al. (1945) The
Foetal Circulation and
Cardiovascular System, and
the Changes That They
Undergo at Birth.
- Haselhorst G, Allmeling A
(1930) Die Gewichtszunahme
von Neugeborenen infolge
postnataler Transfusion.
- Rachmanow AN (1914)
Methode der Nichtunterbin-
dung der Nabelschnur.
- Murray NA, Roberts IAG.
Neonatal transfusion practice.
- Beischer, NA, MacKay EV
(1986) Obstetrics and the
Newborn: An illustrated
textbook, Second Edition.