Umbilical cord clamping

IMPORTANCE: An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support. OBJECTIVE: To test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC). DESIGN, SETTING, AND PARTICIPANTS: This nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit...

OBJECTIVE: To evaluate whether prophylactic administration of 1 g of intravenous calcium chloride after cord clamping reduces blood loss from uterine atony during intrapartum cesarean delivery. METHODS: This single-center, block-randomized, placebo-controlled, double-blind superiority trial compared the effects of 1 g intravenous calcium chloride with those of saline placebo control on blood loss at cesarean delivery. Parturients at 34 or more weeks of gestation requiring intrapartum cesarean delivery after oxytocin exposure in labor were enrolled...

INTRODUCTION: The transition to newborn life has typically been studied in intubated and mechanically ventilated newborn lambs delivered via caesarean section (CS) under general anaesthesia. As a result, little is known of the spontaneous breathing patterns in lambs at birth, particularly those at risk of developing respiratory distress (RD). We have developed a method for delivering spontaneously breathing near-term lambs to characterise their breathing patterns in the immediate newborn period...

OBJECTIVES: In the beginning of the COVID-19 pandemic, delayed umbilical cord clamping (CC) at birth may have been commonly discouraged despite a lack of convincing evidence of mother-to-neonate SARS-CoV-2 transmission. We aimed to systematically review guidelines, reports of practice and to analyze associations between timing of cord clamping and mother-to-neonate SARS-CoV-2 transmission during the early phases of the pandemic. METHODS: Major databases were searched December 1, 2019 to July 20, 2021...

Around the world, very few babies require a more intensive resuscitative effort for stabilization. The optimal timing of an intact umbilical cord to help with resuscitation is controversial. Our objective in the review is to compare the outcomes of neonatal resuscitation with and without an intact umbilical cord. A search of six electronic database libraries was explored for data released between 2014 and 2023. A manual search of secondary references in relevant studies was also performed. Studies focused only on randomized controlled trials comparing the outcomes of neonatal resuscitation with and without an intact umbilical cord at any gestational age...

BACKGROUND: Hyperoxygenation has shown promise in improving suspicious fetal heart patterns in women in labor. However, the effect of hyperoxygenation on neonatal outcomes in women in labor with pathologic fetal heart rate tracing has not been studied. OBJECTIVE: This study aimed to evaluate the effect of fractional inspiration of oxygen of 80% compared with fractional inspiration of oxygen of 40% on neonatal outcomes in women with pathologic fetal heart rate tracing...

OBJECTIVE:  There is no recommendation in the literature on optimal positioning of the newborn immediately at birth during delayed cord clamping. To evaluate if prone positioning on the mother's chest at birth during delayed cord clamping leads to a higher hematocrit at 30 hours of life compared to supine positioning. STUDY DESIGN:  A randomized unblinded trial comparing prone and supine position of the newborn before umbilical cord clamping...

BACKGROUND AND OBJECTIVE: The conventional technique of general anesthesia induction during a Cesarean section involves the use of opioids only after cord clamping. We hypothesized that the use of remifentanil before cord clamping might reduce the use of maternal supplemental anesthetic agents and improve the maternal hemodynamics status and neonatal adaptation of the preterm neonate. METHODS: A phase III, double-blind, randomized, placebo-controlled, hospital-based trial enrolled parturients undergoing a Cesarean section under general anesthesia before 37 weeks of gestation...

INTRODUCTION: Our hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30-60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage. MATERIAL AND METHODS: A prospective, open-label, randomized, controlled trial was conducted at Vall d'Hebron Hospital from July 2014 to December 2018...

<u>Background</u>: Growth-restricted neonates have worse outcomes after perinatal asphyxia, with more severe metabolic acidosis than appropriately grown neonates. The unique cardiovascular physiology associated with fetal growth restriction (FGR) may hinder growth-restricted neonates' cardiovascular response to asphyxia. However, research on asphyxia in FGR is limited. We aimed to compare cardiovascular haemodynamics in preterm growth-restricted and control lambs during mild perinatal asphyxia. <u>Methods:</u> Single umbilical artery ligation induced FGR in one twin, while the other served as a control...

Among various cartilage regeneration treatments, methods using mesenchymal stem cells, whose safety and effectiveness have been verified, are emerging. Mesenchymal stem cell can be implanted through open arthrotomy or arthroscopy. Although arthroscopic surgery has the advantage of earlier recovery and less scar formation compared to open arthrotomy, dry arthroscopy is not technically easy, which is necessary for successful implantation and prevention of washout. This Technical Note will introduce an easier and more effective method of dry arthroscopic mesenchymal stem cell implantation...

UNLABELLED: Recommendations for umbilical cord management in intrauterine growth-restricted (IUGR) neonates are lacking. The present randomized controlled trial compared hemodynamic effects of umbilical cord milking (UCM) with delayed cord clamping (DCC) in IUGR neonates > 28 weeks of gestation, not requiring resuscitation. One hundred seventy IUGR neonates were randomly allocated to intact UCM (4 times squeezing of 20 cm intact cord; n = 85) or DCC (cord clamping after 60 s; n = 85) immediately after delivery...

The aim of the present study, endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Italian Society of Neonatology (SIN), was to analyze the current delivery room (DR) stabilization practices in a large sample of European birth centers that care for preterm infants with gestational age (GA) < 33 weeks. Cross-sectional electronic survey was used in this study. A questionnaire focusing on the current DR practices for infants < 33 weeks' GA, divided in 6 neonatal resuscitation domains, was individually sent to the directors of European neonatal facilities, made available as a web-based link...

The Australian Placental Transfusion Study (APTS) randomised 1,634 fetuses to delayed (≥60 s) versus immediate (≤10 s) clamping of the umbilical cord. Systematic reviews with meta-analyses, including this and similar trials, show that delaying clamping in preterm infants reduces mortality and need for blood transfusions. Amongst 1,531 infants in APTS followed up at two years, aiming to delay clamping for 60 s or more reduced the relative risk of the primary composite outcome of death or disability by 17% (p = 0...

BACKGROUND: Worldwide, more than half a billion women of reproductive age are anaemic. Each year, about 70 000 women who give birth die from postpartum haemorrhage. Almost all deaths are in low-income or middle-income countries. We examined the association between anaemia and the risk of postpartum haemorrhage. METHODS: We did a prospective cohort analysis of data from the World Maternal Antifibrinolytic-2 (WOMAN-2) trial. This trial enrols women with moderate or severe anaemia giving birth vaginally in hospitals in Pakistan, Nigeria, Tanzania, and Zambia...

High-quality gynecologist and midwife training is particularly relevant to limit medical complications and reduce maternal and fetal morbimortalities. Physical and virtual training simulators have been developed. However, physical simulators offer a simplified model and limited visualization of the childbirth process, while virtual simulators still lack a realistic interactive system and are generally limited to imposed predefined gestures. Objective performance assessment based on the simulation numerical outcomes is still not at hand...

Delayed cord clamping (DCC) is beneficial for many infants, and the American College of Obstetrics and Gynecology recommends at least 30-60 seconds of DCC for both term and preterm vigorous infants. For newly born infants that are not vigorous, some evidence in animal models suggests that providing assisted ventilation prior to cord clamping (V-DCC) leads to a more stable transition of cerebral, pulmonary and systemic circulation and oxygenation and may confer not only short-term physiologic benefits but perhaps also improvement in clinically important outcomes...

Delayed clamping and cutting of the umbilical cord at birth is standard practice for management for all newborns. Preterm infants may additionally benefit from a combination of ventilation and oxygen provision during intact cord resuscitation. This review highlights both the potential benefits of such a combined approach and the need for further rigorous studies, including randomized controlled trials, of delivery room management in this population.

No abstract text is available yet for this article.

The benefits of delayed cord clamping have been investigated in multiple studies and supported by various professional associations. Other aspects of umbilical cord management strategies occurring after cord clamping have not been fully thoroughly analyzed. This article will explore and deliberate elements of umbilical cord nonseverance, vascular access management, and blood banking.