Residual Placental Blood Volume Research Articles

Effects of Umbilical Cord Management Strategies on Stem Cell Transfusion, Delivery Room Adaptation, and Cerebral Oxygenation in Term and Late Preterm Infants.

Background:The umbilical cord blood contains a high concentration of stem cells. There is not any published study evaluating the amount of stem cells that have the potential to be transferred to the infant through placental transfusion methods as delayed cord clamping (DCC) and umbilical cord milking (UCM). The aim of this study is to measure the concentrations of endothelial progenitor cell (EPC) and CD34+ hematopoietic stem cell (HSC) in the placental residual blood volume (PRBV), and evaluate the delivery room adaptation and cerebral oxygenation of these infants.MethodsInfants with ≥36 gestational weeks were randomized to receive DCC (120 s), UCM, or immediate cord clamping (ICC). EPC and CD34+ HSC were measured by flow cytometry from the cord blood. PRBV was collected in the setup. The cord blood gas analysis and complete blood count were performed. The heart rate (HR), oxygen saturation (SpO2), and cerebral regional oxygen saturation (crSO2) were recorded.ResultsA total of 103 infants were evaluated. The amount of PRBV (in ml and ml/kg) was higher in the ICC group (p < 0.001). The number of EPCs in the PRBV content (both ml and ml/kg) were the highest in the ICC group (p = 0.002 and p = 0.001, respectively). The number of CD34+ HSCs in PRBV content (ml and ml/kg) was similar in all groups, but nonsignificantly higher in the ICC group. The APGAR scores at the first and fifth min were lower in the ICC group (p < 0.05). The mean crSO2 values were higher at the 3rd and 10th min in the DCC group (p = 0.042 and p = 0.045, respectively). cFOE values were higher at the 3rd and 10th min in the ICC group (p = 0.011 and p < 0.001, respectively).ConclusionThis study showed that placental transfusion methods, such as DCC and UCM, provide both higher blood volume, more stem cells transfer to the infant, and better cerebral oxygenation in the first minutes of life, whereas many lineages of stem cells is lost to the placenta by ICC with higher residual blood volume. These cord management methods rather than ICC do not require any cost or technology, and may be a preemptive therapeutic source for diseases of the neonatal period.

The Association Between Placental Residual Blood Volume and Two Placental Transfusion Methods After Delivery at Term.

Background: Despite reports of the beneficial effects, such as increasing hemoglobin level and iron store in the neonatal period, of delayed cord clamping, or umbilical cord milking after delivery in healthy term-born infants, the duration of delayed clamping or rounds of milking in most previous reports were determined arbitrarily and varied widely across different studies.Methods: We prospectively recruited 80 women with normal singleton pregnancies at 38–40 weeks' gestation. Participants were classified according to the mode of delivery and randomly assigned to either collecting blood from the placenta by umbilical cord drainage (CD) or cord milking (CM), with the placenta left in the uterus. The volume of blood collected, the duration of CD, and the number of rounds of CM were recorded.Results: Collected placental residual blood volume positively correlated with birth weight, placental weight, and length of the cord. When 80% of the total placental residual blood volume collected was set as the threshold, more than 80% of women who delivered vaginally reached this level within 60 s of CD or seven repetitions of CM. This amount of blood could be obtained within 120 s of CD or after seven repetitions of CM in more than 80% of women who underwent cesarean delivery.Conclusion: In most women, regardless of birth weight and placental weight, more than 80% of placental residual blood volume could be collected by CD within 60 s after vaginal delivery, 120 s after cesarean delivery, and seven repetitions of CM in both vaginal and cesarean deliveries.

Less Residual placental blood volume left when cord pulsation ceases than when early cord clamping at 60 seconds

Objectives: Our goal was to test the volume of residual placental blood volume (RPBV) left with delayed cord clamping occurring when pulsation of the umbilical artery ceases as compared to early cord clamping at 60 seconds along with an assessment of its effects on maternal and neonatal outcomes. Materials and Methods: From March to June 2015 in Haikou maternal and child health hospital, 403 single-term patients with normal vaginal births and healthy babies were enrolled with randomization into two groups. The experimental group (n = 201) received delayed cord clamping after pulsation of the umbilical artery ceased with the control group (n = 202) having the umbilical cord cut at exactly 60 seconds. RPBV was collected when the cord was cut in both groups. Maternal and neonatal conditions were recorded. Results: In the control group, RPBV per birth weight (RPBV (mL/kg) range) [21.0 ± 14.9 (2.9-73.2)] was higher than that in experimental group [4.3 ± 3.5 (0.8 - 19.1)] (p &lt; 0.01); peak total serum bilirubin (TSB) level (mg/dL) [(13.6 ± 3.5) (5.0 - 20.7) mg/d1] was higher in the control than that in experimental group [11.9 ± 2.9 (4.5 - 24.5)] (p &lt; 0.01); and postpartum blood loss in control group [(187.8 ± 104.6) (80-650.00) mL] was higher than that in experimental group [(160.2 ± 72.9) (70 - 450) mL] (p = 0.02). Maternal age, gestational age and Apgar score at one and five minutes were not of statistically different between groups. No neonatal deaths were recorded in either group at one month’s follow up. Conclusions: Delayed cord clamping until the umbilical artery pulsation ceased is a safe intervention and reduces the residual placental blood volume without any adverse maternal or neonatal effects. The data suggests that more placental transfusion occurs in the newborn with delayed cord clamping.

Comparison of cut and intact cord milking regarding cerebral oxygenation, hemodynamic and hematological adaptation of term infants

Objective Although both delayed umbilical cord clamping and intact umbilical cord milking (I-UCM) provide the effective placental transfusion at birth, these procedures may not be used in neonates needing resuscitation. The aim of this study is to investigate the effect of cut umbilical cord milking (C-UCM), which permits resuscitation during an immediate transition period (ITP). Methods Sixty-two healthy term infants were randomly divided into C-UCM and I-UCM groups at birth. Approximately 30-cm length of cord was milked towards the baby 2–4 times within 20 seconds after birth in both C-UCM and I-UCM groups while the umbilical cord was cut in the former, and intact in the latter. Heart rate, arterial oxygen saturation (SpO2), cerebral regional oxygen saturation (crSO2) (2nd–15th min), blood pressure (BP) (within 15–30 min), residual placental blood volume (RPBV), and hemoglobin levels (at the sixth hour) were monitored during ITP. Results There were no significant differences in terms of mean gestational age (w) [(39.0 ± 1.2) versus (38.8 ± 1.1)], birth weight (g) [(3351.45 ± 254.30) versus (3256.94 ± 285.52)], Apgar scores at the 5th min (10 ± 0 versus 10 ± 0), first breathing time (sec) (5.4 ± 3.8 versus 5.7 ± 4.1), SpO2, crSO2, BP (mmHg) [(52.9 ± 6.9) versus (51.8 ± 5.7)], hemoglobin levels (g/dl) [(17.7 ± 1.8) versus (18.4 ± 1.4)], and RPBV (ml/kg) [(23.9 ± 4.7) versus (22.9 ± 5.4)] between C-UCM and I-UCM groups (p > .05). Conclusion This study showed that C-UCM is as effective as I-UCM on cerebral oxygenation, hemodynamic and hematological adaptation of term infants in ITP. We suggest that C-UCM can provide additional placental transfusion in term neonates exposed to early cord clamping.

Residual Placental Blood Volume Estimation to Measure the Increase in Neonatal Blood Transfer by Delayed Cord Clamping: A Quasi-Experimental Study

Residual Placental Blood Volume Estimation to Measure the Increase in Neonatal Blood Transfer by Delayed Cord Clamping: A Quasi-Experimental Study

Comparing of Residual Placental Blood Volume When Cord Pulsation Ceased with Early Cord Clamping at 60 Seconds

Comparing of Residual Placental Blood Volume When Cord Pulsation Ceased with Early Cord Clamping at 60 Seconds

Mathematical bias in assessment of placental residual blood volume.

Mathematical bias in assessment of placental residual blood volume.

The Effects of Placental Transfusion on Placental Residual Blood Volume and 24 to 48‐hour Hemoglobin and Serum Bilirubin in Term Newborns: A Randomized Controlled Trial

PurposeTo determine if newborns who receive a full placental transfusion at birth differ in placental residual blood volume (PRBV) and 24 to 48‐hour hemoglobin (Hb) and total serum bilirubin (TSB) levels compared to newborns who receive no placental transfusion.Research QuestionWill newborns who receive a full placental transfusion have less PRBV, a higher 24 to 48‐hour Hb, and no difference in peak TSB compared to newborns who receive no placental transfusion?SignificanceThe usual maternity care practice in the United States is to immediately clamp the umbilical cord (immediate cord clamping [ICC]) at the time of birth. When ICC occurs, 20% to 40% of the fetal‐placental blood volume (containing iron‐rich red blood cells) is left behind in the placenta, potentially leading to lower iron stores in infancy.MethodsA prospective randomized controlled trial was conducted. Seventy‐three healthy term pregnant women with singleton fetuses were enrolled. At birth, they were randomized to either ICC (&lt;20 seconds; n = 36) or delayed cord clamping (DCC) (≥5 minutes; n = 37) and then placed skin‐to‐skin. The primary endpoints were PRBV in mL/kg, Hb (g/dL), and peak TSB at 24 to 48 hours of age. Primary analyses were conducted by intention‐to‐treat and secondary analyses by actual treatment.ResultsMaternal and newborn demographics were not significantly different between groups. Mean (standard deviation [SD]) cord clamping time was 303 (121) seconds (DCC) versus 10 (6) (ICC) seconds (P = .001). Eleven newborns received cord milking as a proxy for DCC at the time of cesarean birth or when resuscitation measures were indicated. There were 9 protocol violations. Newborns randomized to DCC left behind less PRBV (20.0 vs 30.8 mL/kg, P &lt; .001). At 24 to 48 hours of age, newborns exposed to DCC had significantly higher Hb levels (19.5 vs 17.7 g/dL, P = .002) without a difference in peak TSB levels (DCC = 8.5 vs ICC = 9.0 mg/dL, P = .45) compared to infants with ICC. Two newborns in each group had phototherapy.DiscussionNewborns with ICC left behind more PRBV and had lower Hb levels at 24 to 48 hours. There was no difference between the groups on peak TSB levels or other indicators of hyperbilirubinemia. The results support the early hematological advantage of DCC while demonstrating no association with an increase in hyperbilirubinemia.

Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial.

ObjectiveTo measure the effects of a five-minute delay (DCC) versus immediate cord clamping (ICC) on residual placental blood volume (RPBV) at birth, and hemoglobin and serum bilirubin at 24 to 48 hours of age.Study DesignIn this prospective randomized controlled trial, seventy-three women with term (37 to 41 weeks) singleton fetuses were randomized to DCC (≥5 minutes; n=37) or ICC (<20 seconds; n=36).ResultsMaternal and infant demographics were not different between groups. Mean cord clamping time was 303 ± 121 (DCC) versus 23 ± 59 (ICC) seconds (p<0.001) with 10 protocol violations. Cord milking was the proxy for DCC (n = 11) when the provider could not wait. Infants randomized to DCC compared to ICC had significantly less RPBV (20.0 vs 30.8 mL/kg, p<0.001), higher hemoglobin levels (19.4 vs 17.8 g/dL, p=0.002) at 24 to 48 hours, with no difference in bilirubin levels.ConclusionsTerm infants had early hematological advantage of DCC without increases in hyperbilirubinemia or symptomatic polycythemia.

Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: A systematic review and meta-analysis

Evidence suggests that cesarean section is likely associated with a reduced placental transfusion and poor hematological status in neonates. However, clinical studies have reported somewhat inconsistent results. We conducted a systematic review and meta-analysis to examine whether cesarean section affects placental transfusion and iron-related hematological indices. Pubmed, Web of Science, ScienceDirect, and Ovid Databases were searched for relevant studies published before April 9, 2013. Mean differences between cesarean section and vaginal delivery in outcomes of interests (placental residual blood volume; hematocrit level, hemoglobin concentration, and erythrocyte count in cord/peripheral blood) were extracted and pooled using a random effects model. We identified 15 studies (n = 8477) eligible for the meta-analysis. Compared with neonates born vaginally, those born by cesarean section had a higher placental residual blood volume [weighted mean difference (WMD), 8.87 ml; 95% confidence interval (CI), 2.32 ml–15.43 ml]; a lower level of hematocrit (WMD, −2.91%; 95% CI, −4.16% to −1.65%), hemoglobin (WMD, −0.51 g/dL; 95% CI, −0.74 g/dL to −0.27 g/dL) and erythrocyte (WMD, −0.16 × 1012/L; 95% CI, −0.30 × 1012/L to −0.01 × 1012/L). Subgroup analysis showed that the WMD for hematocrit in neonate's peripheral blood (−6.94%; 95% CI, −9.15% to −4.73%) was substantially lower than that in cord blood (−1.75%; 95% CI, −2.82%, −0.68%) (P value for testing subgroup differences <0.001). In conclusion, cesarean section compared with vaginal delivery is associated with a reduced placental transfusion and poor iron-related hematologic indices in both cord and peripheral blood, indicating that neonates delivered by cesarean section might be more likely affected by iron-deficiency anemia in infancy.

Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial

The study's objective was to compare hematocrit (Hct) levels at 36 to 48 h of age in term infants delivered by cesarean section exposed to immediate cord clamping or umbilical cord milking (UCM). In this randomized controlled trial, 24 women scheduled for elective cesarean section were randomized to either immediate clamping (<10 s) or UCM (milked × 5 by the obstetrical provider) at birth. All subjects received their allocated intervention. The milking group had a smaller placental residual blood volume (13.2±5.6 vs 19.2±5.4 ml kg(-1), P=0.01) and higher Hct levels at 36 to 48 h (57.5±6.6 vs 50.0±6.4 %, P=0.01). Five infants (42%) in the immediate group had a Hct of ≤47%, indicative of anemia. UCM results in placental transfusion in term infants at the time of elective cesarean section with higher Hct levels at 36 to 48 h of age.

The effect of early and late umbilical cord clamping on neonatal hematocrit

To compare the effect of early and late cord clamping (LCC) on neonatal hematocrit at 2 and 18 h of life. In this double-blind randomized trial, 64 healthy full-term vaginally born neonates were randomly allocated to either early (30 s) or late (3 min) umbilical cord clamping. During the interval between delivery and cord clamping, the attendant held the neonate supine at the level of the introitus. Neonatal venous hematocrit was measured at 2 and 18 h of life. Neonatal hematocrit at 2 h of life (61+/-4.9 vs 61.6+/-4.5%) and 18 h of life (56.9+/-4.1 vs 56.2+/-3.9%) was not significantly different between the two groups. This was also true for neonatal polycythemia (20 vs 23.5%). In the LCC group, placental residual blood volume (PRBV) was 39.5% lower and estimated neonatal blood volume (ENBV) was 7.1% higher than that in the early cord clamping (ECC) group (P<0.001). Late cord clamping does not lead to a significant difference in the hematocrit level of the neonate or neonatal polycythemia, but is associated with a significant increase in ENBV and a significant decrease in PRBV. Further trials should examine the effect of delaying cord clamping for a longer period of time or changing the position that the neonate is held in to determine whether these variations result in more clinically significant results.

The Effect of Early and Late Cord-Clamping on Blood Viscosity and Other Hemorheological Parameters in Full-Term Neonates

This study was done to compare postnatal alterations in blood viscosity (capillary viscometer) and its determinants: hematocrit, plasma viscosity (capillary viscometer), red cell aggregation (Myrenne aggregometer) and red cell deformability (rheoscope) in the first five days of postnatal life in full-term neonates with early (< 10 s) and late (3 min) cord-clamping. The fetal blood volume of the placenta (residual placental blood volume) decreased from 52 +/- 8 ml/kg of neonatal body weight after early cord-clamping to 15 +/- 4 ml/kg after later cord-clamping. Neonatal blood volume, calculated as the difference between an assumed total feto-placental blood volume of 115 ml/kg and the measured fetal blood volume of the placenta, was 50% higher in the late cord-clamped infants than in the early cord-clamped infants. Both groups showed similar viscosity, hematocrit and other rheological parameters in cord blood. In the infants with early cord-clamping, the hematocrit decreased from 0.48 +/- 0.04 l/l at birth to 0.43 +/- 0.6 l/l after 24 h (p < 0.05). Whole blood viscosity did not change significantly with age. After late cord-clamping, the hematocrit rose from 0.50 +/- 0.04% at birth to 0.63 +/- 0.05 l/l at 2 h of age (p < 0.005) and dropped to 0.59 +/- 0.5 l/l (p < 0.05) at 24 h. Blood viscosity increased by 40% (p < 0.001) within the first 2 h, but did not change significantly during the following five days. In both groups, plasma viscosity and red cell aggregation increased significantly (p < 0.05) on day 5 due to significant increases in total plasma protein and fibrinogen concentrations (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Measurement of human fetoplacental blood volume in erythroblastosis fetalis

The fetoplacental blood volume of the human fetus was measured with the change in hematocrit at the time of intravascular transfusion for severe erythroblastosis. A total of 121 measurements were made between 18 and 31 weeks' gestation. The volume ranged from 117 ml/kg at 18 weeks to 93.1 ml/kg at 31 weeks. These values compare closely with those reported for the sheep fetus and, when they are extrapolated to term, are similar to the blood volume of human newborns plus the residual placental blood volume.

The effect of time of cord clamping and maternal blood pressure on placental transfusion with cesarean section

We measured the residual placental blood volume (RPBV) of 20 infants delivered at term by cesarean section of women not in labor. In all cases, the umbilical cord was clamped within 40 seconds of birth. RPBV decreased significantly with increasing age at cord clamping. In addition, RPBV for infants with cords clamped within 20 seconds of birth correlated inversely with maternal systolic blood pressure (mean RPBV = 54.8 ml. per kilogram at 105 torr and 28.4 ml. per kilogram at 148 torr). However, RPBV did not correlate with maternal blood pressure for the whole group of 20 infants or for those with cords clamped later than 20 seconds after birth. These data indicated that in infants delivered by cesarean section placental transfusion is time related during the first 40 seconds of life and that maternal blood pressure also influences the magnitude of placental transfusion during the first 20 seconds after birth. Analysis of data from this study combined with data from a previous study shows that after 40 seconds the net flow between placenta and infant reverses and that cord clamping delayed beyond this point is accompanied by a rise in RPBV back to the level found when the cord was clamped before 20 seconds.

Role of respiration in effecting transfusion at cesarean section.

The transfer of blood from placenta to baby (placental transfusion) was examined in 29 full-term babies delivered by elective Cesarean Section. Events surrounding the delivery were carefully monitored using a stopwatch. Residual placental blood volume (RPBV) and change in hematocrit (Hct) were measured. In 13 infants held above the level of the placenta, the mean RPBV was significantly greater, and the change in Hct significantly lower, than in 16 infants held below the level of the placenta. Increasing duration of respiration resulted in increasing amounts of placental transfusion, even in those babies held just above the placenta. These results indicate that there are separate effects of gravity and respiration which facilitate a placental transfusion at Cesarean Section.

Cesarean section prevents placenta-to-infant transfusion despite delayed cord clamping

We have adapted and calibrated an accurate method for measuring residual placental blood volume (RPBV). We used this method in 33 normal vaginal deliveries and 18 cesarean section deliveries in which the umbilical cord was clamped from 5 to 118 seconds after delivery. Infants born vaginally received I0 to 20 ml. per kilogram of body weight of placental transfusion when the umbilical cord was not clamped until 30 seconds or more after delivery. Equivalent delay of umbilical cord clamping in cesarean section infants produced no placental transfusion.

The Fetoplacental Circulation During Parturition: Evidence From Residual Placental Blood Volume

The volume of blood left in the fetal part of the placenta after early clamping of the umbilical cord (residual placental blood) was measured in 24 deliveries, and found to be larger among infants born by the vaginal route compared to those born by cesarean section. The result is interpreted as an evidence of a temporary depositing of blood in the placenta during the second stage of labor. As early clamping of the umbilical cord, therefore, among cases of vaginal deliveries, amounts to a blood-letting of about 30 ml of the newborn infant's own blood, it is considered not to be a physiological procedure. The investigation has also demonstrated that the residual placental blood, among cases of vaginally delivered and early clamped infants, fails to represent the intrauterine distribution of the fetoplacental blood volume. Finally, the investigation shows that the placental transfusion, which takes place in late clamped infants, partly originates from previously deposited fetal blood, partly from placental blood. See table in the PDF file. See image in the PDF file. See image in the PDF file.

Blood flow in the umbilical vessels during the third stage of labor.

Blood flow in the umbilical vessels during third stage of labor was studied in 62 normal-term deliveries. Placental residual blood volume (PRBV) was measured as an indicator of net flow of blood into the infant. By clamping the umbilical arteries separately from the umbilical vein in some, at various times after birth, and comparing the measured PRBV with normal values obtained when all three vessels were clamped simultaneously, it was possible to show indirectly reflected in these PRBV, that blood flows in the umbilical arteries during the first 25 sec after birth, perhaps until 40 sec, became negligible after 45 sec, supporting anatomical evidence of closure at this time, while blood flows in the umbilical vein during the first 3 min of birth, largely influenced by uterine contractions, and became negligible after this time.

Perinatal acidosis and placental transfusion.

SummaryUmbilical artery pH and residual placental blood volume (RPBV) were determined for 75 full‐term newborn infants born by vaginal delivery. For 39 infants of multiparous mothers (IMM), there was a significant relationship between fetal acidosis and reduced RPBV. For 36 infants of primiparous mothers (IPM) a significant relationship was not present. Results of an earlier study suggested that perinatal acidosis was associated with reduced RPBV. The present study confirms this association for IMM's. The reason for the lack of a clearcut effect in IPMs is unknown.