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Review
. 2017 Feb;37(2):105-111.
doi: 10.1038/jp.2016.151. Epub 2016 Sep 22.

Placental transfusion: a review

A C Katheria  1 , S Lakshminrusimha  2 , H Rabe  3 , R McAdams  4 , J S Mercer  5   6   7
Affiliations
Review

Placental transfusion: a review

A C Katheria et al. J Perinatol. 2017 Feb.

Abstract

Recently there have been a number of studies and presentations on the importance of providing a placental transfusion to the newborn. Early cord clamping is an avoidable, unphysiologic intervention that prevents the natural process of placental transfusion. However, placental transfusion, although simple in concept, is affected by multiple factors, is not always straightforward to implement, and can be performed using different methods, making this basic procedure important to discuss. Here, we review three placental transfusion techniques: delayed cord clamping, intact umbilical cord milking and cut-umbilical cord milking, and the evidence in term and preterm newborns supporting this practice. We will also review several factors that influence placental transfusion, and discuss perceived risks versus benefits of this procedure. Finally, we will provide key straightforward concepts and implementation strategies to ensure that placental-to-newborn transfusion can become routine practice at any institution.

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Figures

Figure 1
Figure 1
Factors influencing placental transfusion with delayed cord clamping (DCC). Timing of cord clamping, uterine contractions, reduced neonate-to-placental flow due to umbilical arterial spasm, spontaneous respirations and gravity influence the magnitude of transfusion. Reported long-term benefits are shown.
Figure 2
Figure 2
Onset of spontaneous breaths in preterm infants following DCC with stimulation (blue line) and positive pressure ventilation (PPV) with DCC (red line).
Figure 3
Figure 3
Placental transfusion through cord milking with an intact cord (I-UCM) attached to the placenta. Placental blood can potentially increase blood flow to the brain and lungs. Pulmonary vasodilation in response to spontaneous respiration or crying can create a ‘physiologic sink' to accommodate placental blood. Placental blood is a rich source of fetal red blood cells and stem cells.
Figure 4
Figure 4
Cut-umbilical cord milking (C-UCM) is performed by clamping away from the fetus and retaining a long segment of the umbilical cord that can be milked by the neonatal provider simultaneously with resuscitation.
Figure 5
Figure 5
A simple placental transfusion protocol that can be posted in the delivery room.
See this image and copyright information in PMC

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