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Ventilation before Umbilical Cord Clamping Improves the Physiological Transition at Birth
Sasmira Bhatt1, Graeme R Polglase1, Euan M Wallace1
1The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University , Melbourne, VIC , Australia ; Department of Obstetrics and Gynaecology, Monash University , Melbourne, VIC , Australia.
Insights
Facilitating newborn transition at birth is crucial, especially for preterm infants. Establishing infant ventilation before umbilical cord clamping stabilizes cardiovascular function, reducing risks associated with preterm birth.
Area of Science:
- Neonatal physiology
- Perinatal medicine
- Obstetrics
Background:
- Birth transition is critical for neonates, particularly preterm infants with immature cardiopulmonary systems.
- Increasing preterm birth rates necessitate improved management strategies for a smoother transition.
- Current practices in the third stage of labor may not optimize infant transition.
Purpose of the Study:
- To investigate strategies that facilitate the physiological transition of neonates at birth.
- To explore the impact of umbilical cord clamping timing on cardiovascular stability in preterm infants.
- To re-examine third-stage labor management practices for improved neonatal outcomes.
Main Methods:
- Review of recent physiological transition studies at birth.
- Analysis of cardiovascular changes associated with umbilical cord clamping.
- Examination of third-stage labor management, including uterotonic administration timing.
Main Results:
- Establishing infant ventilation before umbilical cord clamping significantly stabilizes cardiovascular transition.
- Delayed cord clamping offers benefits beyond placental transfusion, though not fully understood.
- Avoiding adverse cardiovascular changes during clamping protects preterm infants' vulnerable cerebral vasculature.
Conclusions:
- Ventilation before cord clamping can mitigate risks of cerebral vascular rupture in preterm infants.
- Re-evaluating third-stage labor management, particularly uterotonic timing, is necessary.
- Further research is needed to understand the impact of labor management on neonatal transition.
Abstract:
The transition from a fetus to a neonate at birth represents a critical phase in our life. Most infants make this transition without complications, but preterm infants usually require some form of assistance due to immature cardiopulmonary systems that predispose them to lifelong sequelae. As the incidence of preterm birth is increasing, there is now an urgent need for the development of management strategies that facilitate this transition, which will likely include improved strategies for the management of the maternal third stage of labor. For instance, recent studies on the physiological transition at birth have led to the discovery that establishing ventilation in the infant before the umbilical cord is clamped greatly stabilizes the cardiovascular transition at birth. While most benefits of delayed clamping previously have been attributed to an increase in placenta to infant blood transfusion, clearly there are other significant benefits for the infant, which are not well understood. Nevertheless, if ventilation can be established before cord clamping in a preterm infant, the large adverse changes in cardiac function that normally accompanies umbilical cord clamping can be avoided. As preterm infants have an immature cerebral vascular bed, large swings in cardiovascular function places them at high risk of cerebral vascular rupture and the associated increased risk of mortality and morbidity. In view of the impact that cord clamping has on the cardiovascular transition at birth, it is also time to re-examine some of the strategies used in the management of the third stage of labor. These include the appropriate timing of uterotonic administration in relation to delivery of the infant and placenta. As there is a lack of evidence on the effects these individual practices have on the infant, there is a necessity to improve our understanding of their impact in order to develop strategies that facilitate the transition to newborn life.
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