Umbilical blood flow patterns directly after birth before delayed cord clamping.
BACKGROUND
Delayed umbilical cord clamping (DCC) affects the cardiopulmonary transition and blood volume in neonates immediately after birth. However, little is known of blood flow in the umbilical vessels immediately after birth during DCC. The objective is to describe the duration and patterns of blood flow through the umbilical vessels during DCC.


METHODS
Arterial and venous umbilical blood flow was measured during DCC using Doppler ultrasound in uncomplicated term vaginal deliveries. Immediately after birth, the probe was placed in the middle of the umbilical cord, pattern and duration of flow in vein and arteries were evaluated until cord clamping.


RESULTS
Thirty infants were studied. Venous flow: In 10% no flow was present, in 57% flow stopped at 4:34 (3:03-7:31) (median (IQR) min:sec) after birth, before the cord was clamped. In 33%, flow continued until cord clamping at 5:13 (2:56-9:15) min:sec. Initially, venous flow was intermittent, increasing markedly during large breaths or stopping and reversing during crying, but then became continuous. Arterial flow: In 17% no flow was present, in 40% flow stopped at 4:22 (2:29-7:17) min:sec, while cord pulsations were still palpable. In 43% flow continued until the cord was clamped at 5:16 (3:32-10:10) min:sec. Arterial flow was pulsatile, unidirectional towards placenta or bidirectional to/from placenta. In 40% flow became continuous towards placenta later on.


CONCLUSIONS
During delayed umbilical cord clamping, venous and arterial umbilical flow occurs for longer than previously described. Net placental transfusion is probably the result of several factors of which breathing could play a major role. Umbilical flow is unrelated to cessation of pulsations.
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
I
I
Boere
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
A A W
AA
Roest
The Ritchie Centre, Monash Institute for Medical Research, Monash University, Clayton, Victoria, Australia.
E
E
Wallace
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
A D J
AD
Ten Harkel
Department of Gynaecology and Obstetrics, Leiden University Medical Center, Leiden, the Netherlands.
M C
MC
Haak
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
C J
CJ
Morley
The Ritchie Centre, Monash Institute for Medical Research, Monash University, Clayton, Victoria, Australia.
S B
SB
Hooper
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
A B
AB
te Pas
D001034:Apgar Score; D001724:Birth Weight; D003250:Constriction; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010865:Pilot Projects; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D011446:Prospective Studies; D011673:Pulsatile Flow / Q000502:physiology; D018608:Ultrasonography, Doppler / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D014470:Umbilical Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D014471:Umbilical Veins / Q000000981:diagnostic imaging / Q000502:physiology
birth; cord clamping; umbilical flow