Umbilical Cord Ligation Research Articles

Effect of delayed cord clamping on cerebral hemodynamics in preterm infants

BackgroundUnstable cerebral hemodynamics is an important cause of intracranial hemorrhage in premature infants. The increased blood flow of delayed cord clamping (DCC) compared to immediate cord clamping (ICC) is equivalent to 1/3-1/4 of newborn blood volume. Our objective was to assess whether the increased blood flow causes fluctuations in cerebral blood flow and how. MethodsThis experiment was a prospective, observational study. Neonatologists selected preterm infants eligible for inclusion and exclusion, and divided them into DCC group and ICC group according to the way of umbilical cord ligation performed by obstetrics department, and matched them 1:1 according to gestational age. The peak systolic velocity （PSV) ，end diastolic velocity (EDV)，and resistance index (RI) of middle cerebral artery was measured by Mindray M9 color ultrasonic diagnostic instrument within 1 h, 24±1 h, 48±1 h, 72±1 h, respectively. ResultsThere was no significant difference in PSV, EDV and RI in middle cerebral artery between DCC group and ICC group (P > 0.05). There were no significant differences between groups and time (P > 0.05). The hemoglobin and hematocrit in DCC group were higher than those in ICC group within 2 h after birth (P < 0.05). (P > 0.05). ConclusionDCC can increase hemoglobin and hematocrit in preterm infants, but does not cause cerebral blood flow fluctuation within a certain range. DCC is a safe method of placental transfusion.

Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: A systematic review and meta‐analysis

We aimed to compare perinatal outcomes between umbilical cord occlusion techniques in monochorionic pregnancies, including umbilical cord ligation, fetoscopic laser coagulation, interstitial laser coagulation, bipolar cord occlusion, radiofrequency ablation, and microwave ablation. This study was registered with PROSPERO (CRD42020158861). PubMed, Web of Science, Cochrane Library, and Embase were searched for studies published up to May 2020. The DerSimonian-Laird random-effects model was used for the meta-analysis. Subgroup analyses were performed to compare the outcomes among the six techniques. Meta-regression was used to adjust for confounders. Thirty-four studies with 1646 participants were included. The overall survival was 76.5% after umbilical cord ligation, 78.8% after fetoscopic laser coagulation, 60.3% after interstitial laser coagulation, 79.2% after bipolar cord occlusion, 77.5% after radiofrequency ablation, and 75.0% after microwave ablation. Subgroup comparison showed the rates of overall survival and preterm premature rupture of membranes were not significant different among six techniques. However, rates of fetal loss, premature birth, live birth, and neonatal death differed significantly among the six groups. The choice of umbilical cord occlusion techniques will affect perinatal outcomes. We suggested that the choice of umbilical cord occlusion techniques should fully consider these differences among techniques.

Dr. Joseph Eve Allen. — The aseptic Dressing of the Umbilical Stump. (Americ. Journ. Of obstetrics, 1894, IV, pp. 457-461). Aseptic cord ligation

In protesting against the routine of midwives tying the umbilical cord of newborns, Dr. Allen cites a number of facts that indicate the infection of children by this path; death from tetanus, erysipelas, diphtheria and septicemia he attributes to contamination of the umbilical cord ligation.

Obstetric and neonatal outcomes of delayed interval delivery in cerclage: A retrospective study

ObjectiveDelayed delivery is sometimes selectively performed in twin pregnancy when the first birth occurs inevitably in order to improve the prognosis and decrease the morbidity and mortality of the second twin. The aim of this study is to explore the maternal and fetal outcomes of pregnancies in which cerclage is carried out following the loss of first fetus in twin gestation for delayed interval delivery. MethodsThree cases of delayed-interval delivery of dichorionic-diamniotic twin pregnancies were reported in our center between 2017 and 2018 and were retrospectively analyzed. Once the first twin was delivered, the second twin was left in utero and the patient underwent in utero percutaneous umbilical cord ligation, antibiotics, tocolytic therapy and cervical cerclage. ResultsMean gestational age at delivery of the first fetuses was 21.6 ± 2.9 weeks and 24.8 ± 4.0 weeks for the remaining fetuses, respectively. The mean interval of the delay was 22 days (4–50 days). Mortality of the first fetus was 66.7%, and the retained one was 33.3%. In general, maternal outcome was good, one patient experienced postpartum hemorrhage and placenta accreta. However neonatal aftermath was generally not favorable, probably due to extreme prematurity. ConclusionsCervical cerclage after the first delivery could prolong the pregnancy until an adequate gestational age at which an enhanced prognosis and better perinatal outcome for the second twin can be achieved.

Selective feticide in management of complicated monochorionic twin pregnancies in second trimester

Objective To compare the outcomes of selective feticide by umbilical cord ligation (UCL) , bipolar cord coagulation (BCC) and radiofrequency ablation (RFA) in the treatment of complicated monochorionic twins. Methods We retrospectively analyzed all cases of complicated monochorionic twin pregnancies treated at Peking University Third Hospital from August 2008 to December 2014. The indications for surgery included severe twin-to-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR) (type Ⅱ and Ⅲ), twin reversed arterial perfusion sequence (TRAP) or discordant anomaly. One-way ANOVA, LSD t test, Mann-Whitney U test, Chi-square or Fisher's exact test were used for statistical analysis. Results (1) A total of 68 patients chose selective feticide by different techniques, including fetoscopic UCL (n=18, UCL group) and ultrasound-guided RFA (n=46, RFA group). The other four patients treated by bipolar cord coagulation (BCC) were excluded. The maternal age, proportion of assisted reproductive technology, indications, gestational age and mean birth weight all showed no differences between the two groups (P>0.05). One case of anterior placenta was found in UCL group, fewer than in the RFA group (27 cases, 36.9%) (χ2=4.853). No fetal loss occurred within two weeks in UCL group, but there were seven cases (seven cases, 15.2%) of earlier fetal loss in RFA group (χ2=4.952). The median operation time was (63.2±22.5) min in UCL group, and longer than in the RFA group (33.3±11.4) min (t=5.165), all P<0.05. (2) The gestational age of TTTS and TRAP patients for feticide was older than patients with sIUGR and discordant anomaly [(22.7±3.0), (22.8±3.2), (20.3±2.5) and (20.4±3.6) weeks, respectively, F=2.957, P=0.040]. Fetal loss rate within two weeks in patients with discordant anomaly was higher than in other groups (4/11 vs 1/10, 0/23 and 1/15, P<0.05). The survival rate, gestational age at delivery and mean birth weight showed no significant differences among the four groups. (3) Compared with feticided fetuses at the upper uterine cavity, the fetal loss rate was higher, and the operation time, gestational age at delivery, birth weight and neonatal survival rate were lower than those performed at the lower uterine cavity, but the difference was not significant. Conclusions RFA provides similar outcomes of selective feticide in complicated monochorionic twins compared with UCL, while RFA is easier to operate. Key words: Twin, monochorionic; Pregnancy reduction, multifetal; Pregnancy trimester, secondly

Medicolegal Evaluation of Infanticide Pattern in Assiut Governorate, Egypt from 2008 to 2013 (a Retrospective Study)

Infanticide is a crime that has been practiced in all societies since the down of humanity. This retrospective study was conducted to assess the magnitude and evaluate the pattern of infanticide in Assiut Governorate from 2008 to 2013 as well as to study the reasons and suggest the solutions for this crime. The pattern was assessed through examination of the medicolegal reports of infanticide cases which referred to the Assiut Medicolegal Department of Ministry of Justice during this period. Infanticide cases were evaluated as regards the number, annual, seasonal and geographical distribution, ways of notification of the crime, places of concealments of the infants, infant's wrapping, recognition of the victims and accused identities, as well as the gender, condition of umbilical cord, stage of maturity, causes and time passed since death. Thirty five new born infants were found. The biggest number of cases was found in the years 2011 (8 cases) and 2012 (8 cases). The highest percentage of cases occurred in winter and summer months which represented 42.85% and 31.43% of total case respectively. The highest percentage of cases was found in Abnoub and El Fateh center then Manfalout center which represented 28.57% and 22.86% of total cases respectively. The common places of concealment of the infants were rubbish heaps (31.43%), canals water (22.86%), around and inside buildings (20%) and upon a bridges (14.29%). Infants with wrappings were found in 54.29% while infants without wrappings were found in 45.71% of total cases. Identity of infants and suspects of the crime was recognized in 8.57% of the total cases. The percentage of females (60%) was more than males (40%). Non medical ligation of the umbilical cord was found in 65.72% of total. Full term mature infants represented 88.57% while preterm infants represented 11.43% of total cases. The commonest causes of death were head injuries (48.57%) followed by omission (of feeding, coverings and umbilical cord ligation) occurred in 28.57% % of total cases while unidentified cause of death represented 23.81% of total cases due to advanced putrefaction. Time passed since death was determined in 65.71% while it was not determined (corpses kept in refrigerators) in 34.29% of total cases. This study suggest to solve this problem to put a specific legislations of infanticide, write a standard medicolegal report about cases, increase public awareness to search and notify about infanticide cases, improve economic and educational states especially of females, active the security and religious roles to prevent illegal sexual relationships, give attention to social care institutions for infants of unknown parentage and treat mothers which have psychiatric disorders.

Monozygotic twinning: A 5 year experience in a large IVF center doing blastocyst transfers on day 5

Monozygotic twinning (MZ) is estimated to occur in 3–4/1000 live births. Up to a 4-fold increase in MZ has been reported after ART. Our objective is to assess MZ incidence, chorionicity and amnionicity following IVF using autologous and donor eggs. Retrospective review of all IVF cycles from 2000–2004 at a university-based infertility center. When patients were subjected to an early 1st trimester transvaginal ultrasound (TVU), MZ was suspected if there were 2 fetal poles in a gestational sac or the total number of yolk sacs, fetal poles or heartbeats exceeded the number of embryos transferred. When MZ was suspected, a follow-up TVU was done 2–4 weeks later to assess fetal viability and scan for a dividing membrane in sacs with >1 fetus; if seen, the placentation was monochorionic-diamniotic (M-D); if not, it was monochorionic-monamniotic (M-M). When the number of gestational sacs exceeded the number of embryos replaced, the pregnancy was dichorionic-diamniotic (D-D). Delivery outcome was assessed. 6,668 patients conceived 2866 pregnancies of which 67 were MZ: 47 and 20 followed embryo transfer (ET) of autologous (mean age 36 ± 4) and donor oocytes. Fourteen occurred post-day 3 ET and 53 post-day 5 ET. A follow-up TVU was performed in 43 patients: 37 (86%) were M-D, 5 (12%) were D-D, and only 1 (2%) was M-M. Nine women elected to reduce the MZ fetus pair; the M-D pregnancy had umbilical cord ligation of a single twin. One or more liveborns were delivered in 84% of the MZ pregnancies. Only 26 of 86 fetuses in the MZ sets, all M-D, were born live, including 7 fetuses remaining as part of a MZ pair. 14 MZ twins were spontaneously lost in women who also had another fetus in utero and this singleton was delivered alive. Seven patients underwent therapeutic abortion for chromosomal abnormalities. In this review, 86% of MZ pregnancies were M-D and only 1 was M-M. These findings contrast with Alikani's (2003) report that 37% of MZ were M-M. This clinic-to-clinic M-M difference is difficult to explain. Our results suggest that, although the overall incidence of MZ increases with ART (and more specifically with blastocyst culture), the incidence of M-M does not increase over that reported for naturally conceived MZ gestations. Finally, that we did not visualize embryo splitting throughout culture to Day 5, questions whether MZ splitting for a D-D or M-D pregnancy occurs during this period.

Monozygotic triplet pregnancy following egg donation and transfer of single frozen-thawed embryo

To describe a case of monozygotic triplet pregnancy following egg donation and the transfer of a single frozen-thawed embryo. Case report. District general hospital and regional department of fetal medicine in northeast England. A 38-year-old woman with a 2-year history of primary infertility due to severe endometriosis and poor ovarian reserve who conceived after egg donation and transfer of a single frozen-thawed embryo. Transfer of a single frozen-thawed embryo and delivery of three identical female infants by emergency caesarean section because of preterm labor at 32 weeks' gestation. Review of effect of assisted conception on monozygotic twinning rates. Healthy outcome for all three infants. Assisted reproductive treatments may lead to disturbances in zona pellucida architecture and an increase in monozygotic twinning rates. Couples need to be informed of this and the increased risks associated with these pregnancies before they begin with treatment.

Partial amniotic carbon dioxide insufflation (PACI) facilitates fetoscopic interventions in complicated monochorionic twin pregnancies

Adequate visualization of the placenta or umbilical cord during fetoscopic procedures in complicated monochorionic twin pregnancies may be difficult because of placental position and spatial constraints, as well as stained amniotic fluid. Partial amniotic carbon dioxide insufflation (PACI) has made it possible to overcome these obstacles in other fetoscopic procedures, but its value has not yet been reported in monochorionic twins. Partial amniotic carbon dioxide insufflation was carried out in five expectant women with complicated monochorionic twin pregnancies between 19 + 6 to 29 + 4 weeks of gestation when adequate fetoscopic visualization of pathological placental surface vessels or the umbilical cord was impossible because of stained or too little amniotic fluid. In four cases, five fetoscopic laser ablations of pathological placental vessels in twin-to-twin transfusion syndrome (TTTS) were performed. In one discordant twin pregnancy with TTTS, PACI was carried out in order to achieve umbilical cord ligation in a recipient with omphalocele and cardiac malformation. Partial amniotic carbon dioxide insufflation offered superior visualization and did not result in any acute maternal or fetal complications. After fetoscopic laser coagulation, three women delivered one fetus at 27 + 5, two fetuses at 28 + 6, and two fetuses at 35 + 4 weeks of gestation, respectively. One set of twins with TTTS was lost. Following umbilical cord ligation, the surviving twin was delivered at 37 + 2 weeks of gestation. Partial amniotic carbon dioxide insufflation may facilitate fetoscopic procedures in complicated monochorionic twin pregnancies when conventional fetoscopic approaches within amniotic fluid meet difficulties. Further studies are required to allow assessment of benefits, risks, and safety margins of the new approach before it can generally be recommended.

2D and 3D ultrasound-guided endoscopic umbilical cord ligation with bipolar cautery in twin and triplet monochorionic gestations

2D and 3D ultrasound-guided endoscopic umbilical cord ligation with bipolar cautery in twin and triplet monochorionic gestations

OC248: Umbilical-cord occlusion of the donor versus recipient fetus in twin-twin transfusion syndrome

To compare the technical characteristics and perinatal outcome of selected twin-twin transfusion (TTTS) cases treated with primary umbilical-cord occlusion (UCO) of the donor versus the recipient twin. TTTS patients that underwent primary UCO via ultrasound-endoscopic guided umbilical-cord ligation (UCL) or endoscopic umbilical-cord photocoagulation (UCP) were eligible for the study. Primary UCO was offered only if TTTS was Stage III or IV, or if a discordant lethal anomaly was present. UCO of the donor required access to its sac, often needing 2 ports and/or amnioinfusion. Primary UCO was performed in 26 TTTS patients from July 1997–June 2002. Of these 26 patients, UCO was performed in 7 (26.9%) donor twins and 19 (73.1%) recipient twins. UCL was performed in 24 cases, and UCP in 2 cases. Overall, 22 (84.6%) patients had liveborn infants. There were no differences in co-twin survival (85.7 vs. 84.2%), median gestational age at delivery (34.3 vs. 33.9 weeks), and PPROM rate (14.3 vs. 15.8%) whether the donor or the recipient twins, respectively, was the subject of UCO. However, 2-trocar access (42.9 vs. 5.3%, p < 0.05) and amnioinfusion (71.4 vs. 0%, p < 0.05) were more often required in UCO of the donor than of the recipient twin, respectively. Although the median operating time was 72 min. for the donor versus 40 min. for the recipient, this difference was not statistically significant (p = 0.11). Primary UCO of the donor is technically more involved than that of the recipient twin, but perinatal outcomes of the co-twins are comparable.

Anesthesia for Fetal Surgery: Twin Reversed Arterial Perfusion Sequence

It is important to consider the fetal, uteroplacental, and matemal issues when choosing anesthetic technique for fetal surgery. The twin reversed arterial perfusion (TRAP) sequence, or the acardiac anomaly, occurs in 1:100 monozygous multiple pregnancies and in 1:35,000 births. The TRAP sequence is characterized by placental vascular arterio-arterial anastomosis between twin fetuses, one an acardiac/acephalic twin that receives its blood flow from the normal pumping twin, thereby endangering the normal twin by high output cardiac failure. The acardiac twin is nonviable, and perinatal mortality in the pump cotwin exceeds 50% because of cardiac failure and prematurity. This can be managed by fetal surgery. We report on a patient with a 26-wk gestation complicated by an acardiac/acephalic fetus anesthetized for surgical umbilical cord ligation. (Korean J Anesthesiol 2002; 42: 690-693)

Staging of Twin-Twin Transfusion Syndrome

The purpose of this study was to evaluate the prognostic value of sonographic and clinical parameters to develop a staging classification of twin-twin transfusion syndrome (TTTS). Severe TTTS was defined as the presence of polyhydramnios (maximum vertical pocket of > or = 8 cm) and oligohydramnios (maximum vertical pocket of < or = 2 cm). Nonvisualization of the bladder in the donor twin (-BDT) and absence of presence of hydrops was also noted. The middle cerebral artery, umbilical artery, ductus venosus, and umbilical vein in both fetuses were assessed with pulsed Doppler. Critically abnormal Doppler studies (CADs) were defined as absent/reverse end-diastolic velocity in the umbilical artery, reverse flow in the ductus venosus, or pulsatile flow in the umbilical vein. TTTS was staged as follows: stage I, BDT still visible; stage II, BDT no longer visible, no CADs; stage III, CADs; stage IV, hydrops; stage V, demise of one or both twins. Laser photocoagulation of communicating vessels (LPCV) or umbilical cord ligation was performed depending on the severity of the condition. The study was approved by the Institutional Review Board of St. Joseph's Hospital in Tampa and by the Fetal Therapy Board at Hutzel Hospital, Detroit, and all patients gave informed consent. A total of 80 of 108 referred patients met criteria for surgery, but only 65 were treated surgically: 48 with LPCV and 17 with umbilical cord ligation. Complete Doppler data were obtainable in 41 of 48 LPCV patients. Survival rates by stage for one or two fetuses were statistically different (chi-squared analysis = 12.9, df = 6, p = 0.044). Neither percent size discordance nor gestational age at diagnosis were predictive of outcome. Staging of TTTS using the proposed criteria has prognostic significance. This staging system may allow comparison of outcome data of TTTS with different treatment modalities.

Treatment of Acardiac Twinning

Background: The twin reversed-arterial-perfusion sequence is a complication of monochorionic twin pregnancies characterized by the hemodynamic dependence of a “recipient” twin from a “pump” twin. The recipient twin exhibits lethal abnormalities including acardia and acephaly. The pump twin has a mortality rate of 50% as a result of high-output heart failure.Case: The blood supply to an acardiac-acephalus twin was interrupted at 24 weeks’ gestation using endoscopic laser coagulation. The co-twin was delivered at 35 weeks and had an uneventful neonatal course following correction of a persistent patent ductus arteriosus. Review of the literature reveals 22 cases of acardiac twinning treated with invasive procedures, seven of them using endoscopic laser coagulation. Pump twin mortality with fetal surgery was 13.6% in comparison with 50% mortality with expectant management (P < .001).Conclusion: Fetal surgery is the best available treatment for acardiac twinning. Endoscopic laser coagulation at or before 24 weeks and endoscopic or sonographic guided umbilical cord ligation after this gestational age seem to be the best treatments for this condition.

In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestations.

The study was designed to report our experience with in utero percutaneous umbilical cord ligation for selective feticide in pre-viable, abnormal, monochorionic multiple gestations. The selection criteria prior to offering percutaneous umbilical cord ligation included normal anatomy in the other fetus(es), normal karyotype and polyhydramnios, or uterine contractions. The procedure was performed under combined endoscopic and sonographic guidance. Fifteen patients were referred for evaluation and possible treatment. Two patients were excluded because of misdiagnosis. The mean gestational age at the time of the procedure was 21 weeks (range 16-25 weeks). There were ten acardiac twins, one discordant twin with acrania, and two cases of twin-twin transfusion syndrome with a hydropic twin. Percutaneous umbilical cord ligation was accomplished in 11/13 (84%) cases. An average of 8.5 weeks (range 0-18.5 weeks) was gained after percutaneous umbilical cord ligation, and five of 11 patients delivered at or after 30 weeks. Seven of 11 patients undergoing ligation procedures had living children. Premature rupture of membranes occurred within 3 weeks in 4/13 (30%) of cases. In utero fetal demise remote from the procedure occurred in three ligated patients undergoing ligation, in two of which intraoperative bleeding occurred. One fetus with cystic fibrosis died in the newborn period. Percutaneous umbilical cord ligation is an evolving alternative technique for the management of abnormal monochorionic multiple gestations. The advantages of percutaneous umbilical cord ligation over other approaches include complete extravascular interruption of the blood flow in all vessels of the cord. This may prevent postmortem feto-fetal hemorrhage or possible embolic phenomena that may result in death of the normal twin, as seen with intravascular techniques. Percutaneous umbilical cord ligation prior to spontaneous death of a co-twin may also avert the neurological and other complications that may occur in the surviving twin. Technological advances should decrease the observed complications and improve the success rate of the procedure.

Laparoscopic ligation of the umbilical cord of an acardiac fetus

We performed umbilical cord ligation using laparoscopic technique in twins with twin reversed arterial perfusion sequence.

Fetal umbilical cord ligation under ultrasound guidance.

In a patient with severe twin-to-twin transfusion syndrome, ultrasound-guided umbilical cord ligation of the hydropic recipient twin was performed at 27 weeks' gestation. The procedure was successful in arresting the blood flow and was associated with improvement in the condition of the severely compromised donor fetus. At 29 weeks' gestation, premature onset of labor occurred and a healthy baby was delivered by emergency Cesarean section. This report demonstrates the feasibility of ultrasound-guided cord ligation for selective feticide in a case of severe twin-to-twin transfusion syndrome.

Fetal endocrine and renal responses to in utero ventilation and umbilical cord occlusion

Fetal to neonatal transition involves a myriad of endocrine and renal adaptive changes triggered by multiple simultaneous stimuli. We examined the extent to which ventilation and umbilical cord occlusion have an impact on the many endocrine and renal function changes in fetal sheep at 133 +/- 1 day of gestation. Nine fetuses were chronically prepared with an endotracheal tube, vascular and bladder catheters, and an inflatable umbilical cord occluder. After a 2-hour control period fetuses were treated with commercially prepared surfactant and ventilated with 100% oxygen. One hour after the onset of stable ventilation the umbilical cord was occluded and the animals were monitored for 3-hours. In response to ventilation fetal arterial PO2 increased (18 +/- 1 to 86 +/- 29 mm Hg) and remained significantly above control values after cord occlusion. Fetal arterial pH, hematocrit, and mean arterial pressure and heart rate did not change during the study. Ventilation alone evoked significant increases in epinephrine and norepinephrine concentrations. Renal responses to ventilation included significant decreases in urine flow rate, fractional sodium excretion, and fractional water excretion. Neither ventilation nor cord occlusion resulted in significant changes in plasma concentrations of atrial natriuretic factor, arginine vasopressin, and angiotensin II or in glomerular filtration rate, urine osmolality, free water, and osmolar clearances. (1) Mechanical ventilation and oxygenation alone increase circulating fetal catecholamine levels. (2) The addition of umbilical cord ligation has minimal impact on fetal endocrine and renal adaptive responses.

Ligation of the umbilical cord of an acardiac-acephalus twin with an endoscopic intrauterine technique

Fetal acardia is a rare entity that complicates twin gestation. Reported survival of the normal or "pump" twin is below 50%. Perinatal mortality and morbidity typically result from heart failure in the pump twin caused by the circulatory demands of perfusion of the abnormal twin. Conservative management has not improved perinatal survival. A 30-year-old woman with a twin gestation at 18 weeks was diagnosed with acardia acephalus. Congestive heart failure of the pump twin led to an intrauterine endoscopic attempt to ligate the umbilical cord of the acardiac twin. Both twins ultimately died. A variety of invasive techniques have been reported to accomplish occlusion of the acardiac twin's umbilical cord, with inconsistent results. Maternal morbidity was minimal and technical success was achieved with an endoscopic intrauterine technique of umbilical cord ligation. Despite the poor fetal outcome in this case, endoscopic ligation of the acardiac twin's umbilical cord should be considered for treating this unusual complication of twinning.

The umbilical cord: Simplified ligation using new instrument, latex bands, and open-air aftercare

A new instrument with a simple technique of umbilical cord ligation by means of latex bands is described. The advantages of ligating the cord adjacent to the skin level followed by an open-air and hands-off policy of aftercare are discussed. Complete hemostasis is assured. A decreased incidence of cord stump infections was found, aiding in the elimination of the cord as a focus for staphylococcal and other infections. A possibly lessened incidence of umbilical herniation was observed and warrants further study.