> Umbilical cord: when to cut?

The guideline was updated by the American College of Obstetricians and Gynecologists (ACOG) recommends delaying clamping of the umbilical cord from 30 to 60 seconds.

The relationship ofACOG è was published online and appears in the January 2017 of Obstetrics and Gynecology. Update the opinion for 2012 of the Committee, which is focused on the benefits to the premature infants.

The document has been developed by the Committee of the ACOG on the obstetric practice in collaboration with members of the commission Mary A. Mixture, T. Flint Porter, Tamara Tin-May Chao.

For term infants, the delay in the I clamp on, the umbilical cord improves the iron deposits in in the early months, which may help in the development. Low iron, that has been related to decline in cognitive, motor, and ability; behavioral, è più popular in low-income countries, but is also common in high-income countries, with rates ranging from 5% to 25%. The delay of the clamping also increases levels of hemoglobin at the time of birth.

However, in term infants who have had a delay in clamping, c’è a slight increase in the incidence of jaundice that you will requireà phototherapy, così the birth that use this technique should have the tools on hand to detect it and treat it.

According to the guidelines, for premature infants, the delay improves the circulation, increases the amount; of red blood cells, and reduces the needà of blood transfusions. The delay also translates into a lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.

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Emorragia materna

with regard To the mother, the researchers found no increase in postpartum hemorrhage or increase the blood loss at the time of birth, when clamping is delayed.

The authors note that delaying the clamping means not delaying the assistance.

“During the delayed closing of the umbilical cord, should be initiated to care for premature newborn, including drying, stimulation to the first breath or the tears, and the maintenance of the normal temperature with contact skin-to-skin and by covering the child with bed linen dry”.

The authors explain that in some cases, or in some institutions, the delay may not be the best choice, or there may not be enough data to make this choice. “For example, in cases of restriction of fetal growth with Doppler of the umbilical artery abnormal, or other situations in which perfusion to the uterus-the placenta, or the flow in the umbilical cord can be compromised”. The team of neonatal and obstetrician in these cases should make the decision.

Squeezing of the umbilical cord

The ACOG takes no position on the pressing of the umbilical cord, the practice of pushing the blood in the cord towards the baby più times before clamping, stating that there is insufficient evidence for a decision in favour or against it.

The technique is used to increase the transfusion from the placenta to the baby quickly and can be an interesting option when 30-60 seconds of delay are too many, as for example in cases where the baby needs immediate resuscitation, or when the blood pressure of the mother becomes unstable.

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The researchers conclude that “this Is an area of active research, and several studies in progress are examining the possible benefits and risks of squeezing of the umbilical cord compared to the delayed clamping of the umbilical cord, especially in infants extremely preterm”.

Source: Medscape Medical – Obstet Gynecol. 2017; 129: e5-e10. Testo intero di Marcia Frellick

IN ARGOMENTO:

umbilical Cord blood, delaying the cut is good for the child.

The birth

27 dicembre 2016