July 2004
4
Recent
change of opinion
"After waiting until the pulsation in the exposed umbilical cord has perceptibly weakened or disappeared, the child is severed from its mother." DeLee
1930, p330 [45].
"In most clinics the cord is not tied until
pulsation has ceased." Curtis 1933, p 828 [46].
"
If the infant has cried and has respired well for
about five minutes, there is no
advantage in leaving at attached
any longer to the placenta."
FitzGibbon 1937, p 128 [47].
"As soon as respiration is well established, lay
the child on the bed on its
side. Wait for a few minutes until the cord shows signs of ceasing to pulsate
" Johnstone
1949, p 190 [48].
"After waiting until the pulsation in the exposed umbilical cord has ceased, the child is severed from its mother." Greenhill 1951, p 251 [49].
" The cord is cut after about three minutes or
after it collapses." Greenhill 1955, pp280-282 [50].
"After pulsation in the exposed cord has ceased, using dull scissors, the child is separated from its mother."
Greenhill 1965, p 376 [51]
"The cord is clamped and divided as soon as pulsations have ceased." Garrey et al. 1974, p359 [52]
"The umbilical cord should be tied up after its vessels stop pulsating, which occurs in 2-3 min following the delivery of the infant." Bodyazhina 1983, p 156 [53].
"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." Beischer et al. 1986, p 710 [54].
4. Recent change of opinion
Reasons for clamping the cord
early were
stated in many of the above textbooks. Cord around the neck occurs in
about one out of
every four births, and though efforts to loosen the loop are usually
encouraged, often the advice was to clamp the cord to hasten delivery. Eastman, editor of the tenth edition of William's
Obstetrics in 1950 cited other factors such as apnea from anesthesia, quick repair of the
episiotomy, and management of the third stage of labor:
"Whenever possible, clamping
or ligating the umbilical cord should be deferred until its pulsations wane or, at least, for one or two
minutes.
There has been a tendency of
late, for a number
of reasons, to ignore this precept. In
the first
place the widespread use of analgesic drugs in
