Placental Blood: An Under-utilized Resource

2. In such studies denial of placental transfusion impairs pulmonary blood flow and respiratory distress syndrome results. Immediate cord clamping at pre-term delivery became the rule with the development of modern neonatal intensive care units (NICU) without evaluation in controlled studies. Denial of placental transfusion thereby results in measurable hypovolaemia in the pre-term newborn although the haematocrit is “normal”. This simply means that the ratio of plasma to red cells in the blood is normal without indicating the total blood volume3 . While the predicted requirement of blood for a 1kg pre-term baby is about 100ml/kg, the observed values after immediate cord clamping are some 30-50ml/kg less than this. As in the animal studies, the resultant poor pulmonary blood flow at delivery impairs lung adaptation, worsening the baby’s respiratory distress4 . Indeed, poorer outcome in such babies generally correlates with the red cell volume (mass) and blood volume of the baby at birth4 . For pre-term infants the requirement for heterologous donor blood relates both to the intensity and duration of intensive care and to iatrogenic losses, especially during the first four weeks of life; this requirement is hardly offset by recombinant erythropoietin5,6,7 . In contrast to blood transfusion, maintenance of euvolaemia from birth is likely not only to enhance lung adaptation, but also allow stabilization of the intracranial and hepatosplanchnic circulations8 . European Controlled Study of Placental Transfusion at Preterm Delivery This study was set up to objectively study the benefits and possible difficulties of placental transfusion at pre-term delivery and to optimize management of the third stage of labour and therefore the blood volume of the newborn. The infant is resuscitated by the mother’s side before the cord is clamped (up to 90 seconds). The specific endpoints of the study, which is currently in progress in both Caesarian section and vaginal deliveries, are to measure the requirement of the babies for heterologous donor blood transfusion, indices of post-natal lung function, complications of the procedure and its costs. The results of the study, with worldwide implications for perinatal management, are to be reported in late 1998. Term babies may also benefit from placental transfusion, eg in their iron endowment. However, excessive placental transfusion, especially at term deliveries, is a possible hazard as it may cause circulatory overload, polycythaemia, hyperviscosity and neonatal jaundice 9