Early clamping of the umbilical cord during cesarean section

Abstract

Summary 1.Red cell counts and hemoglobin levels were determined in twenty-eight infants, born by cesarean section, whose cords were clamped immediately after delivery of the infant. Observations were made on the first, the third or fourth, and the fifth or sixth days of life. Counts and levels were similarly determined on a control series of twenty-six infants, born uneventfully by the vaginal route, whose cords were also clamped immediately. 2.The red cell counts and hemoglobin levels of the section infants were slightly lower than those of the control infants (just achieving statistical significance) when figures for the same day were compared. 3.The control infants, with their slight neonatal excess of blood, showed a greater fall of red cell and hemoglobin values in their first week until their fifth- and sixth-day readings approached those of the section infants. 4.The control infants showed a greater incidence of jaundice. 5.The failure of red cell counts and hemoglobin levels to reflect the section infant's blood loss when his cord is clamped immediately suggests that his contracting spleen compensates for any deficit, since it is known that his plasma volume is usually corrected within a few minutes. 6.Evidence of greater hemolysis of the control infant's neonatal excess of red cells, and realization that the newborn infant has a considerably smaller vascular bed than the fetus at term, suggests that a placental blood loss, caused by immediate clamping of the umbilical cord, may relieve the infant of a plethora of blood. 7.The data presented here do not substantiate the theory that immediate clamping of the umbilical cord during cesarean section results in critical blood loss or fatal shock.