Delayed Cord clamping ( DCC ) is established way to utilize placental blood for newborn. There is a reluctance , to carry out DCC as it is cumbersome and the obstetrician wants to hand over newborn baby to the neonatologist at earliest so that he / she can concentrate on the mother for further progress of 3rd stage of labour. In my innovation, the only cooperation required from obstetrician is to provide adequate length of umbilical cord. By vertical suspension of umbilical cord, newborn can get at least 25 to 30 ml blood which would otherwise gone waste. This 25 - 30 ml is almost 7-10 % blood volume for the newborn. This additional amount of umbilical cord blood will go a long way in preventing iron deficiency anaemia in infancy. Infants may not require additional iron supplement. Only problem with additional blood is development of neonatal jaundice due to relative polycythemia, which can be easily treated with photo therapy.

1. Delayed cord clamping ( DCC )
Alternative,
Utilisation of Umbilical cord blood
by vertical suspension
Dr Chandrashekhar D Aundhakar
MD DNB (Paed)
Professor , former HOD
Department of Paediatrics KIMSDU Karad

2. Utilisation of Umbilical cord blood
▪The umbilical cord is baby’s lifeline.
▪During pregnancy, it delivers blood and nutrients from the
placenta to the baby.
▪ But the umbilical cord can continue to play a role in baby’s health
after birth – specifically the blood that is still contained within the
umbilical cord and the placenta.

3. Changing views on when to cut the umbilical cord
• Before the 1950s, the umbilical cord usually was cut after it stopped
pulsating, anywhere from one to five minutes after birth.
• After studies showed that more than 90 percent of a baby’s blood
volume was achieved within the first few breaths after birth,
• And no studies could determine the optimal time to cut the cord.
• The time between birth and clamping the cord grew shorter and
shorter.

4. Utilisation of Umbilical cord blood
• Physiologic studies in term infants have shown that a transfer
from the placenta of approximately 80 ml of blood occurs by 1
minute after birth, reaching approximately 100 ml at 3 minutes
after birth .
• Initial breaths taken by the newborn appear to facilitate this
placental transfusion .
• Marked increase in placental transfusion during the initial breaths
of the newborn, which is thought to be due to the negative
intra-thoracic pressure generated by lung inflation

5. Utilisation of Umbilical cord blood
• This additional blood supplies physiologic quantities of
iron, amounting to 40–50 mg/kg of body weight.
•This extra iron has been shown to reduce and prevent
iron deficiency during the first year of life .
•Iron deficiency during infancy and childhood has been
linked to impaired cognitive, motor, and behavioural
development that may be irreversible

6. Waiting to clamp the umbilical cord for 2–3 min,
or until cord pulsations cease
▪Allows a physiological transfer of placental blood to the infant
▪The process referred to as “placental transfusion” the majority of
which occurs within 3 min.
▪This placental transfusion provides sufficient iron reserves for the first
6–8 months of life preventing or delaying the development of iron
deficiency.

7. • A longer duration of placental transfusion after birth also facilitates
transfer of immunoglobulins and stem cells, which are essential for
tissue and organ repair.
• The transfer of immunoglobulins and stem cells may be particularly
beneficial after cellular injury, inflammation, and organ dysfunction,
which are common in preterm birth
Utilisation of Umbilical cord blood

8. News article
regarding
Delayed Cord Clamping

9. Potential benefits to delayed cord clamping
•Increased blood volume
•Increased iron
•Stabilization of heart rate and blood pressure

10. Increased blood volume
• We may require to draw blood from new-born babies for various
tests.
• Premature babies require even more testing, which can lead to
anemia and require blood transfusions.
• Starting out with a higher blood count can help prevent the need
for transfusions

11. Increased Iron:
• Babies who are breastfed require iron supplementation to reduce
the chance of anaemia .
• Supplement of umbilical cord blood may help cut down on that
need.

12. Stabilization of heart rate and blood pressure:
• Premature infants are at increased risk for bleeding into their
brains, which can cause long-term developmental problems for
the infant.
• The increase in blood volume helps stabilize blood pressure and
improve other cardiovascular functioning that reduces the risk of
intraventricular hemorrhage ( IVH )by about 50 %

13. Delayed umbilical cord clamping is associated with
significant neonatal benefits in preterm infants
▪Improved transitional circulation
▪Better establishment of red blood cell volume
▪Decreased need for blood transfusion
▪Lower incidence of necrotizing enterocolitis ( NEC ) and
intraventricular hemorrhage ( IVH )

14. Potential risks to delayed cord clamping
• The extra red blood cells that the baby receives from delayed
cord clamping can lead to relative polycythemia.
• There is increased risk of neonatal hyperbilirubinemia which can
be easily treated by phototherapy.

15. Delayed cord clamping (Maternal factors)
• In a review of five trials that included more than 2,200 women,
delayed umbilical cord clamping was not associated with an
increased risk of postpartum hemorrhage or increased blood loss
at delivery, nor was it associated with a difference in postpartum
hemoglobin level or need for blood transfusion .
• However, when there is increased risk of hemorrhage (eg,
placenta previa or placental abruption), the benefits of delayed
umbilical cord clamping need to be balanced with the need for
timely hemodynamic stabilization of the woman .

16. CLINICAL SITUATIONS INWHICH IMMEDIATED CORD CLAMPING
SHOULD BE CONSIDERED
▪ Maternal - Hemorrhage, Maternal instability or both
- Abnormal placentation ( Previa , Abruption )
▪ Fetal / Neonatal - Need for immediate resuscitation
- Placental circulation not intact (abruption, cord avultion)
IUGR ( abnormal cord color doppler evaluation )

17. ESTABLISHED METHODS OF PLACENTALTRANSFUSION
DELAYED CORD CLAMPING
DCC
UMBILICAL CORD MILKING
UCM
Can we Utilise Umbilical Cord Blood by vertical suspension
As a alternative method

18. Umbilical cord milking (UCM)
• While cord milking can speed up the process, there are no
benefits in rushing through the immediate postnatal period.
• For mother and baby, it is best to have as gentle a transition as
possible

19. My original innovative method of utilisation of Umbilical
Cord Blood by vertical suspension
• Curtain hook connected to the warmer grill which is poor conductor of electricity
• S hook can hold artery forceps helps in vertical suspension of the umbilical cord

20. Utilisation of
Umbilical cord blood
by vertical suspension

21. utilisation of
Umbilical cord blood
by vertical suspension

22. Evan if you do not have warmer, one can suspend the
umbilical cord with the help of peg fixed to the wall

23. My original innovative method of utilisation of
UmbilicalCord Blood by vertical suspension
•Only co-operation is required by obstetrician is to keep
maximum length of umbilical cord by clamping placental
end of umbilical cord nearer to the vulva.
•Obstetrician can continue to take care of the mother.
Without loosing her/ his valuable time .

24. My original innovative method of Utilisation of Umbilical
Cord Blood by vertical suspension
•Once the umbilical cord is suspended vertically, Umbilical
cord blood will continue to gravitate towards the new
born baby.
•Neonatologist can continue his routine neonatal care
while stabilising the baby

25. My original innovative method of utilisation of Umbilical
Cord Blood by vertical suspension
•Evan asphyxiated babies requiring ventilation can be
managed without any hindrance.
•Since umbilical cord blood is gravitating slowly, there is
no sudden hemodynamic load with new born which
might occur with milking of the umbilical cord

26. My original innovative method of utilisation of
Umbilical cord blood by vertical suspension
▪With this esteemed KOGS forum, I request you lend your helping
hand by providing maximum length of umbilical cord.
▪This will help new born in getting additional 25 to 30 ml blood .
▪Which will go in the long way to prevent iron deficiency anaemia
in infancy.

27. My original innovative method of utilisation of
Umbilical cord blood by vertical suspension
▪Advantages of Delayed Cord Clamping ( DCC ) are well
documented
▪Our new method of utilisation of umbilical cord blood by vertical
suspension can be alternative for DCC as it is very easy to
perform.
▪This can be landmark in the care of New born

28. Utilisation of Umbilical Cord Blood
is
Birth right of Neonate !
Please help in the cause!!

30. 01/01/2019
Dear Friends ,
Wishing you very “Happy & Prosperous New Year 2019”.
Herewith, I want to share my innovation with you.
Delayed Cord clamping ( DCC ) is established way to utilize placental blood for newborn.
There is a reluctant mentality, to carry out DCC as it is cumbersome and the obstetrician wants to hand
over newborn baby to the neonatologist at earliest so that he / she can concentrate on the mother for
further progress of 3rd stage of labour.
In my innovation, the only cooperation required from obstetrician is to provide adequate length of
umbilical cord.
By vertical suspension of umbilical cord, newborn can get at least 25 to 30 ml blood which would
otherwise gone waste. This 25 - 30 ml is almost 7-10 % blood volume for the newborn.
This additional amount of umbilical cord blood will go a long way in preventing iron deficiency anaemia
in infancy. Infants may not require additional iron supplement.
Only problem with additional blood is development of neonatal jaundice due to relative polycythemia,
which can be easily treated with photo therapy.
Please go through the PPT & video of Utilisation of umbilical cord blood by vertical suspension.
Please feel free to give feedback to me regarding this article.
Spread this message so that, more and more newborns will be benefited by utilisation of umbilical cord
blood.
Sincerely,
Dr Aundhakar
M.D.DNB (Paed)
Mobile 9960697814