About this Research Topic
Placental transfusion involves the transfer of residual placental blood to the newborn in the immediate postpartum period. This transfusion can be accomplished by three different methods: delayed cord clamping (DCC), intact-umbilical cord milking (I-UCM), and cut-UCM (C-UCM). DCC is defined as clamping the umbilical cord ≥30 seconds after birth or based on physiologic parameters (such as when cord pulsation has ceased or breathing has been initiated), without cord milking. To perform I-UCM, the unclamped umbilical cord is grasped and the blood is pushed (or “stripped”) toward the infant before the cord is clamped. To perform C-UCM, a long segment of the umbilical cord is clamped and cut before passing the newborn, with the long cord segment still attached, to the pediatric provider, who then untwists the cord and milks the entire residual placental contents into the newborn. Both the I-UCM and C-UCM methods can be performed in about 20 seconds, thus allowing quick neonatal resuscitation.
Growing evidence supports umbilical cord management at birth as a potential influence on survival and major neonatal morbidities. However, enthusiasm for adopting UCM is tempered by a lack of strong evidence from large clinical trials and hemodynamic concerns related to rapid cord blood transfusion. Among newborns at 23 to 27 weeks’ gestation, the rate of severe intraventricular hemorrhage (IVH) is statistically significantly higher with UCM than with delayed umbilical cord clamping, but further study is required in such high-risk patients. The current recommendation for umbilical cord management in newborns who exhibit signs of depression at birth and require resuscitation is to immediately clamp the umbilical cord. This recommendation is due in part to insufficient evidence to support UCM in the presence of perinatal distress.
This Research Topic will provide a focus for further evidence to determine the benefits or potential harms of UCM. To compare placental transfusion techniques, well-designed trials are needed, including large-scale randomized controlled studies, prospective trials, original research, molecular studies, and reviews.
This article collection is envisaged to address, but not be limited to, the following themes:
- Process and technique of UCM
- Role of mode of delivery in UCM
- Neonatal outcomes
- Maternal outcomes
- Outcomes among pre-term infants
- Use and outcomes of UCM in multiple gestations
- Concerns related to UCM
- Long term outcomes and follow-up
Growing evidence supports umbilical cord management at birth as a potential influence on survival and major neonatal morbidities. However, enthusiasm for adopting UCM is tempered by a lack of strong evidence from large clinical trials and hemodynamic concerns related to rapid cord blood transfusion. Among newborns at 23 to 27 weeks’ gestation, the rate of severe intraventricular hemorrhage (IVH) is statistically significantly higher with UCM than with delayed umbilical cord clamping, but further study is required in such high-risk patients. The current recommendation for umbilical cord management in newborns who exhibit signs of depression at birth and require resuscitation is to immediately clamp the umbilical cord. This recommendation is due in part to insufficient evidence to support UCM in the presence of perinatal distress.
This Research Topic will provide a focus for further evidence to determine the benefits or potential harms of UCM. To compare placental transfusion techniques, well-designed trials are needed, including large-scale randomized controlled studies, prospective trials, original research, molecular studies, and reviews.
This article collection is envisaged to address, but not be limited to, the following themes:
- Process and technique of UCM
- Role of mode of delivery in UCM
- Neonatal outcomes
- Maternal outcomes
- Outcomes among pre-term infants
- Use and outcomes of UCM in multiple gestations
- Concerns related to UCM
- Long term outcomes and follow-up
Keywords: umbilical cord milking, umbilical cord management, intact-umbilical cord milking, cut-umbilical cord milking, delayed cord clamping, immediate cord clamping, placental transfusion, neonates
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