Nuchal cord management and nurse-midwifery practice – Mercer et al. (2005)
Nuchal cords: sharing the evidence with parents – Reed et al. (2009)
1973: Cashmore J. Usher RH. (1973) Hypovolemia resulting from a tight nuchal cord at birth. Pediatr. Res: 7:339.
1985: Shepherd A., Richardson C., Brown J. (1985) Nuchal cord as a cause of neonatal anemia. Am J Dis Child;139:71–3: Anemia in the tight nuchal cord group was usually observed early, and in three infants was manifest by hypotension, necessitating transfusion.
1987: Vanhaesebrouck P., Vanneste K., De Praeter C., Van Trappen Y., Thiery M.(1987) ‘Tight nuchal cord and neonatal hypovolaemic shock’, Archives of Disease in Childhood, , 62 1276-77
1988: Dunn(1988) Tight nuchal cord and neonatal hypovolaemic shock. Arch Dis Child. 1988 May; 63(5): 570–571.
1991, Schorn and Blanco recommended use of the somersault technique to facilitate birth where the umbilical cord is short or looped tightly around the neck, in order to avoid clamping and cutting the cord.
1994, Iffy and Varadi ‘Cerebral palsy following cutting of the nuchal cord before delivery’ : documenting five cases of pre-birth cord severance followed by a delay in delivery ranging from 3 to 7 minutes. The authors wrote:
“All of these infants were born with a low APGAR score. Subsequently, they displayed manifestations of cerebral palsy and two of them also had permanent brachial plexus lesion. This series of incidents indicates that an unexpected arrest of the shoulders may inadvertently compound the problem that the severing of the cord prior to the delivery of the body entails.”
1999, Reynolds published a family physician practice tip for performing the somersault maneuver, describing it as a “simple way to assist in the birth of a baby with a tight cord”.
2001, Iffy, Varadi and Papp ‘Untoward neonatal sequelae deriving from cutting of the umbilical cord before delivery’, documenting four cases where:
“…following the delivery of the fetal head, the physician electively cut the nuchal cord of the fetus… The writers conclude that the practice of severing the umbilical cord prior to the delivery of the body of the fetus, proposed in some textbooks as a routine procedure, is a dangerous technique, which should be avoided. They also point out that the medical literature has not discussed this problem.”
2005, Mercer, Skovgaard, Peareara-Eaves and Bowman ‘Nuchal cord management and nurse-midwifery practice’. The authors wrote:
“Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence.”
2007, Reed ‘Nuchal Cords: Think Before You Check’, :
“Given the lack of evidence to support cutting a nuchal cord, and the medico-legal evidence against, this procedure could pose a risk management problem for practitioners and Trusts.”
2008, Singh and Sidhu ‘Nuchal Cord: A Retrospective Analysis’:
“…having tight cord around the neck had significantly higher proportion of fetal distress and low Apgar scores at one minute…[the definition of tight cord in this study] When the nuchal cord had to be clamped and cut before delivery, it was called “tight”.”
2008, Mercer, Erikson-Owens and Skovgaard ‘Cardiac asystole at birth: Is hypovolemic shock the cause?’. Featuring two cases studies of immediate clamping and pre-birth cutting of a nuchal cord with serious shoulder dysocia (approximately 6 minutes), the writers hypothesise:
“Immediate cord clamping maintains the hypovolemic state by preventing the physiologic and readily available placental blood from returning to the infant. Loss of this blood initiates an inflammatory response leading to seizures, hypoxic-ischemic encephalopathy, and brain damage or death.”
The Human Umbilical Cord - the umbilical cord and its development, composition and function
Cord Clamping Info – Dr Judith Mercer
Academic OB/GYN blog & videos of Nicholas Fogelson MD
Common Objections to Delayed Cord Clamping – What’s The Evidence Say? Mark Sloan MD (2012)
Hands off the cord – Birth Matters NZ (2012)
The Placenta: essential resuscitation equipment – Reed R (2010)
Nuchal Cords: the perfect scapegoat – Reed, R (2010)
Leaving Well Alone: A Natural Approach to the Third Stage of Labour – Buckley, S (2005)
Neonatal Resuscitation: Life That Failed - Morley, G. (2011)
The following articles do not address cord clamping – the timing and intervention of cord clamping is not mentioned, despite it being common practice to immediately clamp and separate the baby from the placenta/ transfusion /blood/ oxygen supply, in order to commence resuscitative efforts: