Maternal Implications of Placental Transfusion

Elsevier

Available online 17 March 2023, 151733

Seminars in PerinatologyAuthor links open overlay panel, , ABSTRACT

Placental transfusion for 30-60 seconds after delivery is recommended by numerous professional societies and is now a common practice. Numerous studies documented neonatal benefit with minimal maternal risk when routine neonatal stabilization and active management of the third stage of labor are undertaken during the period of delayed cord clamping. Maternal outcomes did not show any increased incidence of postpartum hemorrhage, need for blood product transfusion in the case of vaginal delivery or cesarean section, preterm or term delivery, or in the case of multiple gestations. Fetomaternal hemorrhage is also likely decreased with delayed cord clamping. In the case of fetal anomalies, cord management should be individualized according to each special circumstance, but is unlikely to lead to increased maternal morbidity. While few studies have investigated maternal outcomes with umbilical cord milking, this practice has not been as widely adopted. With careful monitoring of maternal and fetal well-being, a period of placental transfusion following delivery is advised for benefit of the neonate without significant maternal risk.

Section snippetsBACKGROUND

Placental transfusion refers to the auto-transfusion of the placental circulation after birth while the umbilical cord remains intact. This period, often referred to as delayed cord clamping (DCC) in the literature, is currently most commonly defined as cord clamping 30-60 seconds after birth. It is becoming a common practice worldwide due to endorsement by numerous organizations including the World Health Organization, American Academy of Pediatrics, Royal College of Obstetricians and

Postpartum hemorrhage

Globally PPH is the leading cause of maternal mortality.12 PPH is defined as blood loss ≥ 1,000 mL or any blood loss with signs and symptoms of hypovolemia within 24 hours of birth.13 For many years, ECC was recommended as part of active management of third-stage of labor to theoretically reduce PPH.14,15 The more recent systematic review demonstrates a lack of evidence that active versus expectant management effects the rate of severe PPH.5 A critical assessment of maternal management of the

CONCLUSION

Despite the concerns associated with maternal outcomes, the evidence demonstrates no differences in the duration of third stage of labor, maternal PPH, nor maternal transfusion. Most guidelines advocate for active management of the third stage of labor while performing DCC. This practice likely mitigates any theoretical maternal risks.

Declaration of Competing Interest

The authors report no conflicts of interest. Our data is original and is not being considered for publication in any other journal.

Source of Funding

Angie Jelin is funded by grant K23DK119949 from the National Institutes of Health (NIH).

REFERENCES (42)CM Begley et al.Active versus expectant management for women in the third stage of labour

Cochrane Database Syst Rev

(2019)

H Rabe et al.Effect of tim- ing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes

Cochrane Database Syst Rev

(2019)

SJ McDonald et al.Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes

Cochrane Database Syst Rev

(2013)

Postpartum hemorrhage

Obstet Gynecol

(2017)

WJ Prendiville et al.The bristol third stage trial: active versus physiological management of third stage of labour

BMJ

(1988)

WJ Prendiville et al.Active versus expectant management in the third stage of labor

Cochrane Database Syst Rev

(2000)

MC. BothaThe management of the umbilical cord in labour

S Afr J Obstet Gynaec

(1968)

O Andersson et al.Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial

Acta Obstet Gynecol Scand

(2013)

K Mohammad et al.Effects of early umbilical cord clamping versus delayed clamping on maternal and neonatal outcomes: a Jordanian study

J Matern Fetal Neonatal Med

(2021)

D Katariya et al.The Effect of Different Timings of Delayed Cord Clamping of Term Infants on Maternal and Newborn Outcomes in Normal Vaginal Deliveries

Cureus

(2021)

JS Mercer et al.Rethinking placental transfusion and cord clamping issues

J Perinat Neonatal Nurs

(2012)

View full text

© 2023 Elsevier Inc. All rights reserved.

留言 (0)

沒有登入
gif