|should be double-clamped, divided, and placed on the delivery table |
pending assignment of the 5-minute Apgar score."
ACOG Committee on Obstetric Practice (2006) ACOG Committee Opinion No. 348, November 2006:
Umbilical cord blood gas and acid-base analysis. Obstet Gynecol. 2006 Nov;108(5):1319-22.
|The 2005 edition of William's Obstetrics provides the following |
"... Our policy is to clamp the cord after first thoroughly clearing the
airway, all of which usually requires about 30 seconds."
Cunningham FG, Hauth JC, Leveno KJ, Gilstrap L III, Bloom SL, Wenstrom KD, eds,
Williams Obstetrics - Twenty-second edition, New York: McGraw-Hill Medical
Publishing Division, 2005.
What evidence motivated the practice of clamping the cord as
soon as possible after birth?
A single article (from 1974) was cited in Williams 2005 edition, that placental
transfusion raised the risk for hypervolemia and hyperbilirubinemia,
especially in infants born prematurely:
Yao AC, Lind J: Placental transfusion. Am J Dis Child 127:128, 1974
|The protocol for clamping the cord "immediately after birth" is |
|included in a book by Turrentine JE, Clinical Protocols in |
Obstetrics and Gynecology, Second Edition, 2003, with the
(1) Doubly clamp cord segment (10-20 cm) immediately after birth
in all deliveries, and place on table.
(2) pH and acid-base determinations indicated for:
- nuchal cord
- low Apgar scores (< 7 at 5 minutes)
- abnormal antepartum fetal heart tracing
- any serious problem with delivery or neonate's condition
(3) If unable to obtain cord specimen, aspirate artery on chorionic
(4) Discard cord segment if 5 minute Apgar score satisfactory and
Turrentine JE. Clinical Protocols in Obstetrics and Gynecology, Second Edition.
The Parthenon Publishing Group, New York, 2003.
But NOTE: Bilirubin only gets into neurons in areas where the blood-brain
barrier has been damaged by anoxia. This was demonstrated in the experiments
with monkeys on asphyxia at birth. See Lucey et al. (1964) Kernicterus in
asphyxiated newborn monkeys. Experimental Neurology 9:43-58.