Is 2 minutes enough?

Both recently, Farrar & al in BJOG. 2011 Jan;118(1):70-5, report in their results: ”Placental transfusion was usually complete by 2 minutes, but sometimes continued for up to 5 minutes.”

This is perfectly in line with the old classic study by Yao AC, Moinian M, Lind J. in Lancet. 1969 Oct 25;2(7626):871-3, “Distribution of blood between infant and placenta after birth” where “the corrected blood-volume of infant” rose with additional 8.3 ml/kg from 2 to 3 minutes (from 84.5 ml/kg to 92.8 ml/kg)

Farrah & al reported that placental transfusion contributed with 32 ml (95% CI, 30-33 ml) per kilogram of birth weight to blood volume, but 24 ml (95% CI, 19-32 ml) based on inspection.” and “The mean difference in weight was 116 g [95% confidence interval (CI), 72-160 g] using the B-spline and 87 g (95% CI, 64-110 g) using inspection”

In contrast Vain & al, in Lancet. 2014 Jul 19;384(9939):235-40, “Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial” did only 2 minutes cord clamping and demonstrated a mean weight change of 56 g in the introitus group compared with 53 g in the abdomen group (I am surprised that reviewers did not comment this rather low weight gain, implicating a possible incomplete placental transfusion)

In our own RCT; Andersson & al, BMJ. 2011 Nov 15;343:d7157 “Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial” the weight difference between early (less than 10 sec) and delayed (180 sec or more) newborns was 96 g or 26 g/kg implying a placental transfusion of about 90 ml. 

My concern is that by referring to the Vain study (as well as the Chaparro study in Lancet 2006 where DCC also was 2 min) there is a risk that a lot of newborns will be “intermediately clamped” and will not receive the optimal placental transfusion. 

Most likely, you should wait until the umbilical cord goes from blue and thick til it's white and thin. You can find photos illustrating this here:

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