PIMS Short Case Study - Optimal Cord Clamping and Intact Cord Resuscitation

Optimal cord clamping

AIMS supports midwife Amanda Burleigh’s campaign for optimal cord clamping “Wait for White”. Optimal cord clamping is a key part of physiological birth, providing the neonate with a full blood volume and important in helping the transition to extra-uterine life.

See waitforwhite.com for further details.

Collecting Cord Gases with an intact cord

See www.bloodtobaby.com for further details

Bedside resuscitation with the cord intact

Bedside resuscitation with the cord intact allows ventilation to be started before cord clamping, which can help to compensate for hypoxia.

Improved outcomes include:

• earlier stabilisation of blood pressure
• increased blood volume
• increased haemoglobin and iron levels
• reduced risk of anaemia

(Rabe et al, 2019, Robledo et al, 2022).

See waitforwhite.com/intact-cord-resuscitation for further details.

For preterm neonates

For preterm neonates, immediate cord clamping can cause a loss of up to 50% of blood volume (www.waitforwhite.com). Optimal cord clamping for preterm babies reduces risks including intraventricular haemorrhage and sepsis. In fact, for preterm neonates, immediate cord clamping has been shown to increase the risk of neonatal mortality by 28% (Fogarty et al, 2018).

References

• Fogarty, M., Osborn, D. A., Askie, L., Seidler, A. L., Hunter, K., Lui, K., ... & Tarnow-Mordi, W. (2018). Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-anaysis. American journal of obstetrics and gynecology, 218(1), 1-18.
• Katheria, A., Lee, H. C., Knol, R., Irvine, L., & Thomas, S. (2021). A review of different resuscitation platforms during delayed cord clamping. Journal of Perinatology, 41(7), 1540-1548.
• Rabe, H., Gyte, G. M., Díaz‐Rossello, J. L., & Duley, L. (2019). Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews, (9).
• Robledo, K. P., Tarnow-Mordi, W. O., Rieger, I., Suresh, P., Martin, A., Yeung, C., ... & Bowen, J. (2022).
• Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): a multicentre, randomised clinical trial. The Lancet Child & Adolescent Health, 6(3), 150-157.
• Tizard, H (2018) Collecting cord gases with an intact cord , accessed online www.bloodtobaby.com/post/collecting-cord-gasses-with-an-intact-cord