Re: When should the umbilical cord be clamped ... Only relevant in singletons ?
As with so many interesting articles, this paper ignores the fact that due to increasing use of ART, multiple pregnancy is now much more common. With the rise of multiple pregnancy the number of monochorionic pregnancies has also risen, with a concomitant rise in cases of Twin to twin transfusion syndrome. This syndrome, with major implications to fetal outcome, can happen at any stage of pregnancy including intrapartum.
Whilst we make every effort to determine chorionicity at the first trimester scan, the technique is not fool proof and there is often doubt in twins and even more doubt in higher multiples.
Mode of delivery does not influence the risk of inter twin transfusion at birth as the first twin at Caesarean section is always higher than the second during delivery!
The evidence for cord clamping in uncomplicated singleton pregnancies may be reasonably clear but it's applicability to multiple births and complicated singleton births (e.g. Rhesus disease) is not. Clinicians conducting these deliveries should be extremely cautious about delaying cord clamping of the first or subsequent birth in multiples.
Competing interests:
No competing interests
16 September 2015
Ross Welch
Consultant in Fetomaternal Medicine; Associate Professor Plymouth University
Plymouth University and Derriford Hospital, Plymouth
Rapid Response:
Re: When should the umbilical cord be clamped ... Only relevant in singletons ?
As with so many interesting articles, this paper ignores the fact that due to increasing use of ART, multiple pregnancy is now much more common. With the rise of multiple pregnancy the number of monochorionic pregnancies has also risen, with a concomitant rise in cases of Twin to twin transfusion syndrome. This syndrome, with major implications to fetal outcome, can happen at any stage of pregnancy including intrapartum.
Whilst we make every effort to determine chorionicity at the first trimester scan, the technique is not fool proof and there is often doubt in twins and even more doubt in higher multiples.
Mode of delivery does not influence the risk of inter twin transfusion at birth as the first twin at Caesarean section is always higher than the second during delivery!
The evidence for cord clamping in uncomplicated singleton pregnancies may be reasonably clear but it's applicability to multiple births and complicated singleton births (e.g. Rhesus disease) is not. Clinicians conducting these deliveries should be extremely cautious about delaying cord clamping of the first or subsequent birth in multiples.
Competing interests: No competing interests