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NEWS: Owen Dyer UK hospitals that offer cord blood collection will need licence from July BMJ 2008; 336: 981 [Full text]

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Regulate for safety of the baby

David JR Hutchon   (3 May 2008)

Regulate for safety of the baby 3 May 2008
David JR Hutchon, Consultant Obstetrician and Gynaecologist Darlington Memorial Hospital. DL3 6HX Send response to journal: Re: Regulate for safety of the baby	The licensing of cord blood collection and storage by the Human Tissue Authority is very welcome. (1) This regulation will ensure that care workers are not distracted from the immediate and direct care of the mother and baby at birth. As Belinda Phipps of the NCT points out, care must be taken to ensure that the baby is not deprived of its own cord and placental blood. Peter Braude has also pointed out that collection conditions can influence the likelihood of stem cells being obtained from the umbilical cord blood samples collected. Volume is one of these conditions and it is undisputed that early cord clamping increases the residual volume of blood in the cord and placenta, and increases the chance of successful collection. The RCOG expert group on cord blood chaired by Professor Braude conclude that there should be no alteration in ‘usual management’ of the third stage. (2) This assumes that current ‘usual management’ of the third stage is optimal. The recent NICE intrapartum care guideline recommends women be offered an “active management package” or a physiological third stage. (3) Early cord clamping is included as an essential element of this package. However the inclusion of early cord clamping is without an evidence base, and encourages the usual practice of early cord clamping at birth, to the detriment of the baby. (4) I trust that the licensing authority will take into account the health of the baby (5) within its regulations for cord blood collection. David J R Hutchon FRCOG References 1. Owen Dyer UK hospitals that offer cord blood collection will need licence from July BMJ 2008; 336: 981 2. Umbilical Cord Blood Banking. RCOG Scientific Advisory Committee Opinion Paper 2http://www.rcog.org.uk/index.asp?PageID=545 3. National Institute for Health and clinical excellence (NICE) (2007) Intrapartum care: care of healthy women and their babies during childbirth- Clinical Guideline 55. Available from: www.nice.org.uk Accessed 24.10.07. 4. Soltani H. Has NICE considered the evidence comprehensively in relation to the "Intra-partum Care Guideline: Management of the Third Stage of Labour"? http://bmj.com/cgi/eletters/334/7595/651-a#193439, 10 Apr 2008 5. Hutchon D. A view on why immediate cord clamping must cease in routine obstetric delivery. The Obstetrician and Gynaecologist. 2008;10:112-116 Competing interests: None declared