Abstract
Over the past decade, there have been several studies and reviews on the importance of providing a placental transfusion to the newborn. Allowing a placental transfusion to occur by delaying the clamping of the umbilical cord is an extremely effective method of enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery. However, premature and term newborns who require resuscitation have impaired transitional hemodynamics and may warrant different methods to actively provide a placental transfusion while still allowing for resuscitation. In this review, we will provide evidence for providing a placental transfusion in these circumstances and methods for implementation. Several factors including cord clamping time, uterine contractions, umbilical blood flow, respirations, and gravity play an important role in determining placental transfusion volumes. Finally, while many practitioners agree that a placental transfusion is beneficial, it is not always straightforward to implement and can be performed using different methods, making this basic procedure important to discuss. We will review three placental transfusion techniques: delayed cord clamping, intact umbilical cord milking, and cut-umbilical cord milking. We will also review resuscitation with an intact cord and the evidence in term and preterm newborns supporting this practice. We will discuss perceived risks versus benefits of these procedures. Finally, we will provide key straightforward concepts and implementation strategies to ensure that placental-to-newborn transfusion can become routine practice at any institution.
Highlights
The transition to extrauterine life is characterized by changes in circulation and initiation of ventilation and oxygenation via the lungs
Delaying clamping of the cord (DCC) decreases the overall incidence of intraventricular hemorrhage (IVH), enthusiasm for DCC is tempered by the lack of benefit for severe IVH and/or death in addition to the small numbers of newborns included in these trials and concerns about reporting bias [28]
We speculate that improved cerebral blood flow, oxygen carrying capacity, increased pulmonary arterial pressure, and reduced ductal shunt following placental transfusion may contribute to reduced IVH observed in preterm infants following DCC [28]
Summary
The transition to extrauterine life is characterized by changes in circulation and initiation of ventilation and oxygenation via the lungs. About one-third of the blood flows through the placenta and two-thirds flows through the fetus at any point in time [1] It follows that immediate cord clamping (ICC) results in one-third of total blood volume remaining in the placenta. Delaying clamping of the cord (DCC) for 60 s decreases the residual placental blood to 20% and by 3–5 min the residual placental volume is approximately 13% [2]. Mercer and Erickson-Owens found that term infants placed on the maternal abdomen immediately after birth who were assigned to DCC for 5 min received a significantly larger placental transfusion than those with a 2-min delay [8], and more recently found that term infants placed skin to skin had significantly less residual placental blood volume than infants with immediate clamping [9]
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