Late umbilical cord cutting
After the newborn is delivered, the umbilical cord will continue to pulsate, and the blood exchange between the placenta and the newborn will continue for a period of time, until the newborn's lungs open and begin to breathe, this short period is called the fetal-to-newborn transition period.
Waiting for the newborn's respiratory function to establish and stabilize after childbirth, the placenta to the newborn's blood transfusion stops (the pulsation of the cord disappears or lasts longer), and then the umbilical cord is cut, called late cord clamping DCC.
Cutting the umbilical cord as soon as a child is born has long been seen as a "standard practice" after the birth of a newborn, however, this behavior has been questioned and denied in recent years.
The legendary grandfather of Charles Darwin, Who wrote On the Origin of Species, Erasmus Darwin, also thought in 1794 that it was not good to tie the umbilical cord too quickly. He believes that the umbilical cord should be ligated again after the pulsation has stopped. He said: "The tying and cutting of the navel string should always be left till the child not only repeatedly breathed but till all the pulsation in the cord ceases."
Authorities such as the American College of Obstetricians and Gynecologists, the World Health Organization and the International Federation of Obstetricians and Gynecologists also recommend late umbilical cord cutting for newborns. The call for late umbilical cord cutting is getting louder and louder, and "late umbilical cord cutting" has become the consensus of obstetric experts at home and abroad.
However, our pregnant mothers will still hear or see such a statement: late umbilical cord cutting has side effects, which will cause an increase in the aggregation and destruction of red blood cells in the baby's body in a short period of time, and easily cause neonatal jaundice and erythrocytes.
In the past decade or so, a large number of clinical studies have been done to figure out whether late umbilical cord cutting will cause these risks to newborns.
In 2007, a meta-analysis published in the American Medical Journal, the first of the four major international medical journals, showed that in eight studies involving 1912 term newborns, there was no significant difference in the risk of jaundice within 24 to 48 hours between the early cord group and the late cord closure group. Neonatals in the late umbilical group had an increased probability of erythrocytosis within 24-48 hours, but they were not harmful to the neonatal body.
The latest meta-analysis of 1828 newborns from the Cochrane database also showed that late cord cutting did not increase the incidence of neonatal jaundice.
Currently, none of the above risks have been present in all clinical randomized controlled trials and meta-analyses of late cord cutting in term or premature infants.
At the same time, it has been found that there is no research or evidence so far that premature umbilical cord cutting can have a good impact on newborns, and traditional early umbilical cutting is only widely used because of convenience!
The importance of late umbilical cord cutting
BENEFITS OF DELAYED CORD CLAMPING
The so-called late umbilical cord is to cut the umbilical cord after the newborn's umbilical cord stops pulsating. After the baby is born, 1/3 of the blood remains in the contiguous placenta and umbilical cord, which needs to be injected into the baby through the pulsation of the umbilical cord.
Now, let's talk about what kind of benefits this 1/3 of the precious blood can bring to your baby's body.
The Importance of Late Umbilical Cord Cutting 1
Immediate benefits
Premature/low-weight infants
Increase the number of red blood cells and hemoglobin content in newborns, improve blood pressure, red blood cell mobility and brain tissue oxygenation
Reduces the risk of anemia, respiratory distress, intraventricular hemorrhage, delayed sepsis, and necrotizing enterocolitis in newborns, and improves survival in preterm infants
Shorten the time to oxygen in newborns and reduce the need for mechanical ventilation, blood transfusions, and pulmonary surfactant therapy
Full-term children
Provides adequate blood volume and iron reserves
Provide infants with a more adequate amount of blood volume and red blood cells, allowing newborns to make a smoother transition to lung respiration
Mother
Reducing placental congestion can shorten the length of the third stage of labor and reduce the incidence of placental retention
Reduces postpartum bleeding in mothers
Long-term benefits
The importance of late umbilical cord cutting 2
May be beneficial for neurodevelopment in young children in men
Increase hemoglobin in young children at 10 weeks of age
Improve haematological status (hemoglobin and hematocrit) in young children aged 2-4 months
Improve iron nutrition levels in young children at 6 months of age and reduce the incidence of anaemia
The following is a process of late umbilical cord cutting and blood flow back.
The umbilical cord when the baby is just born,
It was thick, dark purple, still pulsating.
A steady stream of delivery for your baby
Precious, unique, important residual blood.
Gradually thinning
Thinner and whiter
Blood is still flowing back
Now the blood transmission is almost complete
The transmission of the umbilical cord is complete and the umbilical cord stops pulsating.
It was now thin, fluffy and soft, and looked very white.
WHO (World Health Organization):
It is currently recommended to postpone at least 1 minute until 3-5 minutes later before cutting the umbilicus.
Premature babies need to have their umbilicus cut even more late, as nearly half of the blood is still in the placenta.
At the time of birth, the baby carries 2/3 of the blood that was previously shared with the placenta and umbilical cord to form the "Trinity", and 1/3 of the blood is still in the placenta and umbilical cord at the moment of birth, which needs to be injected into the baby's body through the pulsation of the umbilical cord. What benefits can this 1/3 of the blood bring to our children?
(1) Oxygen and immune substances
From the moment a newborn is born, it means switching from the way oxygen was previously obtained from the placental umbilical cord to breathing with lungs, and in 2012, Goer and Romano mentioned that late umbilical cord cutting can provide babies with more adequate blood volume, increase the number of red blood cells, and make the newborn's transition to lung breathing more smoothly. (Mercer, 2002; see also Goer and Romano, 2012, page 403) and immune substances stored during pregnancy also need to be passed on to the child through the bloodstream.
(2) Iron
In 2012, Downey and Blewly proposed that iron deficiency anemia in infants became a common phenomenon due to routine early umbilical cord cutting, and in 2011, it was also studied that late umbilical cord cutting can reduce the probability of iron deficiency anemia in 4-month-old infants. （Andersson, et al, 2011）
(3) Stem cells
The concentration of stem cells in the blood of the fetus is higher than ever.
In a 2010 study, scholar Tolosa mentioned that stem cells play a huge role, participating in the development and maturation of many organ systems, such as the central nervous system, respiration, cardiovascular and so on.
Late umbilical cord cutting may be an alternative "stem cell therapy"
It can reduce the risk of neonatal disease, including pneumonia, chronic lung disease, and eye disease, and find more significant significance in studies of late umbilical cord cutting behavior in premature infants: late umbilical cord cutting can reduce the incidence of cerebral hemorrhage, late-onset sepsis, anemia, and reduce the chance of premature babies requiring blood transfusions.
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The voice of doubt
Some "doctors" scare pregnant women into saying that late umbilical cord cutting will cause jaundice in newborns, is it true?
Preserving placental-derived stem cells: the choice of young parents
Scientists have found that the placenta is rich in hematopoietic stem cells, subtopotent stem cells, mesenchymal stem cells and maternal stem cells, which are important sources of stem cells. Many parents choose to entrust the placenta to a professional stem cell preservation agency at the time of the birth of the child, from which valuable hematopoietic stem cells, subtopotent stem cells, mesenchymal stem cells and maternal stem cells are extracted and stored for a long time in case the child grows up and the future of family members.
If you are trying to conceive or are pregnant, what will you do with your placenta? Leave it to the doctor, discard it yourself, or stock up on your child's "peace of mind"? Moms can think about it in advance!
Finally, let's look at this chart, the cover of the latest edition of the WORLD Guidelines for Newborns, published in 2014, which has shown the popularity and importance of Delayed umbilical cord clamping.
Summary of late umbilical cord cutting knowledge:
01 Night umbilical cord break and breathe.
After the birth of the newborn, the blood circulation between the placenta and the newborn still exists, the umbilical cord is still beating, to go through a short time (estimated at 4-6 minutes), after the pulmonary blood vessels are filled, the alveoli open, after a short period of time, so that the fluid in the lungs (lung fluid) is absorbed by the circulatory system and lymphoid tissue, so that the blood oxygen partial pressure rises to establish effective breathing, when the blood oxygen partial pressure rises to a certain extent, it will lead to the closure of the umbilical artery, the disappearance of the umbilical cord pulse, and thus physiologically terminate the blood exchange process between the placental newborns.
In the fetal circulation, the partial pressure of umbilical vein blood oxygen is about 32 mmHg, the partial pressure of umbilical artery blood oxygen is about 15 mmHg, and the partial pressure of blood oxygen in the umbilical artery after birth gradually increases with the establishment of breathing, and when it rises to 36 mmHg, the umbilical artery contracts and closes, and the umbilical artery pulse stops. Thus physiologically ligating the umbilical cord, the umbilical cord blood will not flow out again, this is a naturally designed physiological procedure, even if we do not tie the umbilical cord, the newborn is safe.
In this short process, where the lungs begin to breathe, but have not yet functioned as an oxygen supply, the circulation of the umbilical cord plays a compensatory role, which is the greatness of nature's design.
02 Late umbilical cord cutting increases neonatal hemoglobin, iron and stem cell levels.
Plancenta transfusion This process provides adequate blood for lung expansion in newborns Studies have found that about 80-150 ML of blood is passed to the newborn through a placental transfusion after birth (increased capacity of pulmonary circulation).
Neonatal erythrocytes destroy a part after birth, but iron remains in the body, thereby increasing the stock of postnatal ferritin and reducing the incidence of iron deficiency anemia Disease In early physiological studies, it was noted that the placental blood volume of full-term pregnancy accounts for 25%-60% (54-160 ml) of the total fetal placental circulating blood volume, and is rich in hematopoietic stem cells. Premature umbilical cord cutting leads to the lack of hematopoietic stem cells in newborns, and early umbilical cord cutting is an important cause of neonatal anemia.
03 Late umbilical cord cutting does not increase pathological jaundice.
Studies have shown that late umbilical cord cutting does not increase the level of pathological jaundice, nor does it increase the chance of neonatal phototherapy. Shi Xiaoliang and other related studies pointed out that appropriate delay in umbilical cord cutting time can not only improve the blood volume of newborns, increase the concentration of hemoglobin and do not occur polycythemia and hyperbilirubinemia.
04 Late umbilical cord closure reduces postpartum bleeding.
In the 2003 Joint Statement on Measures to Prevent Postpartum Haemorrhage, the International Federation of Midwifery and FIGO, in which the cord was cut off after waiting for the cord beat to stop, was classified as one of the effective measures of "active third-stage labour management" as a measure that could prevent postpartum haemorrhage. After 2007, the WHO guidelines for the prevention of postpartum haemorrhage tended to delay clamping and ligation of the umbilical cord.
The results showed that the maternal postpartum haemorrhage in the late umbilicus was reduced, the neonatal bilirubin level (the highest postnatal 1 value) was lower than that of the early umbilical cord group, and there was no statistically significant difference in the number of neonatal anemia and the number of people requiring phototherapy between the two groups. Regression analysis, late cord cutting reduced neonatal asphyxia during vaginal delivery, reduced the five-minute choking rate after waiting for umbilical cord pulsation to stop and waiting for placental delivery after umbilical cord cutting, there was no obvious difference for newborns, which was a safe and effective measure.
05 Cesarean section late umbilical cord closure reduces neonatal asphyxia.
During the caesarean section, a late umbilical cord is also performed, the newborn can be placed between the mother's legs to keep warm, and the placenta is removed after the umbilical cord beat disappears and can be handed over to the operating table for treatment. Domestic studies have shown that late umbilical cord cutting during caesarean section can reduce neonatal asphyxia, reduce neonatal admission to NICU, and do not increase postpartum haemorrhage.
06 Late umbilical cord cutting improves the survival quality of premature babies.
Not only do term babies have to be cut late, but late umbilical cords are more important for the health of premature babies. Premature infants are immature, body temperature is not easy to maintain, vital signs are unstable, late umbilical cords are broken at birth, no fetal fat is removed, immediate early contact between mother and child is conducive to respiratory establishment, encourage kangaroo-style hug care, and help the growth and development of premature babies.
Studies have found that late cord cutting is an important factor in protecting the health of premature infants, reducing intracranial hemorrhage by 50%, reducing respiratory complications, reducing late-onset infections, reducing the need for blood transfusions and ventilators in newborns, and improving the quality of survival.
07 late umbilical cord closure reduces neonatal asphyxia is conducive to neonatal resuscitation.
Late umbilical cord cutting plays an important role in the process of rescuing newborn asphyxia, delayed umbilical cord cutting can make the fetus get more placental blood perfusion, increase the probability of rescue success, and the incidence of neonatal sequelae is significantly lower than that of the early umbilical cord group.
The classics of Chinese medicine emphasize that where a woman has a difficult childbirth, labor injuries the fetal qi, although there are many children who are detached and weak and dying, or who have died, they must not break the umbilical cord, when they urgently use a large paper twist dipped in sesame oil, burn it back and forth on the umbilical cord, take its yang qi to continue the fetal yuan, Russian, the child has to cry, that is, it is already alive. Whoever sees this, if the umbilical cord is broken with a knife, it will be difficult for the mother and child to be protected.
For newborns born in the breech position, because there is a brief process of umbilical cord compression, the establishment of breathing may be a few seconds later than that of the first newborn, and the umbilical cord must not be cut, which will cause breathing to not be established normally, endangering the newborn.
08 Late Umbilical Cord Cutting Research Ethics.
Current scientific research evidence shows that late umbilical cord cutting is beneficial to mother and child, while early umbilical cord cutting is not evidence and is harmful to the health of mother and child, so late umbilical cord cutting should be implemented.
In related studies, the effects of late umbilical cord cutting at different times and different disease states can be studied, and the study of early umbilical cord can be studied again. That is, do not artificially divide newborns into early umbilical cord group in order to do research.
Instead of storing cord blood, storage of the umbilical cord and extraction of mesenchymal stem cells from the umbilical cord can be implemented.
09 evening umbilical cord cutting operation process.
Newborns deliver (between the mother's legs), dry amniotic fluid with a large clean towel to keep warm, rapid preliminary assessment (constant umbilicus) assess vital signs, and breathing is established.
Early postpartum contact between mother and child: direct skin contact.
Early sucking (do not interrupt the process, there is no need to ligation the umbilical cord, the umbilical cord does not flow backwards).
Process reset: contact --- sucking--- mother to replenish water (within 1 hour) --- write medical records, wait for the umbilical cord to turn white, cut the umbilical cord with sterile scissors, do not need to lay sterile towels, can be operated on the mother, and finally weigh and height to improve the newborn medical records.
The content of the article is from: Professor Zhang Hongyu: Evidence and Significance of Late Umbilical Cord Cutting