Dear Editor,
I welcome publication of even more conclusive evidence on the increased mortality after early cord clamping at preterm birth. Clearly gestational age represents a spectrum and while the harm of early cord clamping is most readily identified in preterm babies, it will inevitably also harm term babies to a lesser extent.
It is well recognized that early clamping of the cord results in the loss of the placental transfusion and therefore always a degree of neonatal hypovolemia. Hypovolaemia at birth is sometimes the underlying cause of the failure of the term newborn to respond to positive pressure ventilation resuscitation. The late Professor Peter Dunn (1) emphasized this in his letter in 1988 as being most marked in babies with a tight nuchal cord. He pointed out that “When the umbilical cord was clamped at the moment of birth, as much as 30-40% of the normal fetal blood volume might be trapped within the placental vasculature rendering the placenta congested, tense, bulky, and more likely to be retained.” Unless this is recognized, and volume, ideally an emergency transfusion of uncross-matched O-neg blood is given, the baby is likely to die, or at best suffer significant hypoxic ischemic brain injury.
The hazard can be totally avoided by leaving the cord unclamped for as little at 30 seconds. The baby with a tight nuchal cord must be delivered with the cord intact, if necessary using the somersault manoeuvre. (2) Might a change in obstetric practice contribute to the RCOG commitment to reduce early neonatal mortality and severe neonatal brain injury by 50% by 2025?
David J R Hutchon FRCOG [email protected]
References
1. Dunn P. Arch Dis Child: 10.1136/adc.63.5.570-a on 1 May 1988 Tight nuchal cord and neonatal hypovolaemic shock
2. Mercer JS, Skovgaard RL, Peareara-Eaves J, Bowman TA. Nuchal cord management and nurse-midwifery practice. J Midwifery Womens Health. Sep Oct 2005;50(5):373-9
The harm of early cord clamping is not limited to preterm babies.