Placental transfusion after cesarean delivery
Landau et al. (1950) described the respiratory distress that often afflicted infants
born by cesarean section. They compared the symptoms with those of hematogenic
shock, and they described how the delivery procedure might be the cause:
"Usually at the time of cesarean section as soon as the uterus is opened the
operator delivers the infant as rapidly as is consistent with the infant's
safety. The cord is clamped and cut immediately and the infant is handed to
the waiting assistant...
...This is in marked contrast to the procedure during normal or vaginal
delivery. At this time the cord is not clamped and severed until pulsations
have ceased."
Landau et al. (in Hannibal Missouri) thus practiced what Apgar and her colleagues
referred to as "slow birth." Landau et al. further commented:
"The thought occurred to us that the immediate clamping and cutting of the
cord might be the essential point of difference between the cesarean- and
the normally delivered infant."
They proceeded to adopt a new procedure for cesarean deliveries:
"The assistant designated to care for the infant is scrubbed and stands to
the left of the operator. After the infant is delivered from the uterus this
assistant holds the infant by the legs with the head down. The pharynx is
aspirated by means of a rubber bulb syringe. The cord is neither clamped
nor severed. The placenta is separated from the uterus and wrapped in a
large turkish towel...
...The placenta is suspended from a standard by means of a clamp attached
to the towel...
...The cord is not cut until its blood vessels have collapsed. It is then
clamped, cut, and tied in the usual manner. The placenta is usually drained
and the cord collapsed in from six to ten minutes."
Landau et al. commented that in 87 sections done since instituting this technique,
there were no instances of respiratory distress, and that for this reason they did not
feel justified in running a control series. This seems far more ethical than the current
academic standard requiring random assignment of subjects to groups to receive a
treatment or to not receive the treatment.
- 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.