Importance of Delay Cord Clamping in Newborns

What is the correct time for umbilical cord clamping? In the early 1900's obstetric practitioners shifted from the early (20-30 sec) to delayed (approx 3 mins) umbilical cord clamping. It is not understood why modern practitioners has reverted to the early cord clamping but many speculated that with hospital overcrowding and need to get mothers out of the labour room quickly may be a factor. Some may say it prevents polycythemia in newborns but despite what the reason may be, there is no evidence that early cord clamping is beneficial to both mother and child (WHO).

The World Health Organisation (WHO) started campaigning for the practice of late cord clamping in the effort to improve maternal and child nutrition, health and development. Posted below are some facts to justify this practice:

1.      40 ml per kg of placental blood transferred to the infant after a delay in clamping of at least 3 minutes.



Reproduced from van Rheenen, P. F et al. BMJ 2006;333:954-958 with permission from the BMJ Publishing Group. - http://www.paho.com/



2.      Below chart outlines the short term and long term benefits of delay cord clamping (PAHO):



PAHO - CA - Beyond Survival - http://www.paho.org/



The current method practice, obstetric practitioners cut the cord within seconds of birth. The cord is usually milked to remove as much maternal blood within the cord for the newborn. While this may contribute to an increase in blood supplied to the newborn, research has shown that the umbilical vein continuously receive blood from the placenta within the first 3 minutes of birth. Thus with delay cutting of the cord, for approximately 3 minutes, can significantly reduce the chances of anemia in the new born and thus decrease the need for risky blood transfusion.

I remembered during my clinical training in Obstetrics, one of my colleagues was placed on antiretroviral medication because she was exposed to the patient blood during the cutting of the cord.  Within those 3 minutes after birth, the cord is distended with blood and still pulsatile, thus there is a risk of having spillage of blood from the cord. Waiting until the cord is relaxed and there is no pulsation can further protect the practitioner from becoming expose.

So is this a common practice in your facility?

For more information on Delay Cord Clamping practices please visit http://www.paho.org/

Medical Breakthrough for 2010

Times magazine has released its top 10 Medical Breakthrough for 2010. Sitting on top of the list is, "AIDS drug lowers the risk of HIV infection." I agree that this is one of the most striking pieces of research that been published this year. With over 36 million people worldwide infected and millions more at risk, i am enthusiastic that science has taking a big leap towards trying to curbing this devastating pandemic. While there is no vaccine identified, scientists has however found that the antiretroviral drug, Truvada, reduce the risk of HIV infections in high-risk groups by 73% in patients who were compliant to their medication, when compared to the placebo group. There was however a 44% overall reduction. I know these percentages may not seem like an attractive figure but to us it is a good 'play field' for more welcoming results.

There were also many successes in stem cell research for 2010. The most admirable was the fact that stem cell drug, known as GRNOPC, was approved in the treatment of spinal cord injury. In October, it was announce that Shepherd Center, a spinal cord and brain injury rehabilitation center in Atlanta, has started using this drug. GRNOPC contains cells that produce myelin, a coating that allows nerves to move along nerves. If myelin is reproduce on the damage nerves then there is a possibility that signals can once again be transmitted at that location and the patient can once again regain function of that affected areas.

While there were many successes in 2010 in medical research there are still many haunting illnesses knocking on the doors of science. I am excited to see new vaccines, more potent stem cell breakthrough and of course answer to the 'whys', the 'hows' and 'whens' in medical sciences.

Times Magazine 2010 Top 10 Medical Breakthrough 
More about Truvada