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Extra-uterine placental transfusion and intact-cord stabilisation of moderately preterm to term infants in caesarean deliveries - A feasibility study with historical control (INTACT-2)

Sæther, Elisabeth ; Andersson, Ola LU orcid ; Myklebust, Tor Åge ; Bjellmo, Solveig ; Bernitz, Stine ; Stridsklev, Solhild and Eriksen, Beate Horsberg (2025) In Early Human Development 202.
Abstract

Background: Although delayed umbilical cord clamping (DCC) is universally recommended, implementation has been difficult in caesarean deliveries. The study objective was to test if extra-uterine placental transfusion (delivering the placenta before cord clamping) to facilitate intact-cord stabilisation could be a feasible and safe alternative to DCC (≥ 1 min) for moderately preterm to term infants with caesarean delivery in regional anaesthesia and their mothers. Methods: This feasibility study included infants with GA 320 to 423 weeks with planned or emergency caesarean delivery. Primary outcome was intervention compliance. Safety outcomes were prevalence of blood loss ≥1000 ml or postoperative wound infection in... (More)

Background: Although delayed umbilical cord clamping (DCC) is universally recommended, implementation has been difficult in caesarean deliveries. The study objective was to test if extra-uterine placental transfusion (delivering the placenta before cord clamping) to facilitate intact-cord stabilisation could be a feasible and safe alternative to DCC (≥ 1 min) for moderately preterm to term infants with caesarean delivery in regional anaesthesia and their mothers. Methods: This feasibility study included infants with GA 320 to 423 weeks with planned or emergency caesarean delivery. Primary outcome was intervention compliance. Safety outcomes were prevalence of blood loss ≥1000 ml or postoperative wound infection in mothers, and prevalence of early cord clamping (ECC), low 5-min Apgar scores and hypothermia in infants. Results: We included 123 mother-infant pairs in the intervention group and 158 in the historical control group. The intervention was successfully completed in 121 of 123 cases. There were no statistically significant differences in maternal outcomes. Significantly less infants in the intervention group had ECC before 60 s (OR 0.07, CI (0.01–0.51), P = 0.009) and 5-min Apgar scores <7 (P = 0.003) compared to historical controls. There was no significant difference in infant hypothermia. Conclusion: Extra-uterine placental transfusion may be a reasonable alternative to DCC for term and near term preterm infants with caesarean delivery in regional anaesthesia. The intervention may be especially useful in low-income birth settings with high prevalence of iron deficiency/anaemia and no mobile resuscitation equipment.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Caesarean, Delayed cord clamping, Infant, Intact-cord stabilisation, Placental transfusion, Umbilical cord clamping
in
Early Human Development
volume
202
article number
106208
publisher
Elsevier
external identifiers
  • scopus:85217152369
  • pmid:39933476
ISSN
0378-3782
DOI
10.1016/j.earlhumdev.2025.106208
language
English
LU publication?
yes
id
c2e1edb2-4f24-486d-a7e6-9db3e35281b7
date added to LUP
2025-03-24 13:31:55
date last changed
2025-08-25 23:41:31
@article{c2e1edb2-4f24-486d-a7e6-9db3e35281b7,
  abstract     = {{<p>Background: Although delayed umbilical cord clamping (DCC) is universally recommended, implementation has been difficult in caesarean deliveries. The study objective was to test if extra-uterine placental transfusion (delivering the placenta before cord clamping) to facilitate intact-cord stabilisation could be a feasible and safe alternative to DCC (≥ 1 min) for moderately preterm to term infants with caesarean delivery in regional anaesthesia and their mothers. Methods: This feasibility study included infants with GA 32<sup>0</sup> to 42<sup>3</sup> weeks with planned or emergency caesarean delivery. Primary outcome was intervention compliance. Safety outcomes were prevalence of blood loss ≥1000 ml or postoperative wound infection in mothers, and prevalence of early cord clamping (ECC), low 5-min Apgar scores and hypothermia in infants. Results: We included 123 mother-infant pairs in the intervention group and 158 in the historical control group. The intervention was successfully completed in 121 of 123 cases. There were no statistically significant differences in maternal outcomes. Significantly less infants in the intervention group had ECC before 60 s (OR 0.07, CI (0.01–0.51), P = 0.009) and 5-min Apgar scores &lt;7 (P = 0.003) compared to historical controls. There was no significant difference in infant hypothermia. Conclusion: Extra-uterine placental transfusion may be a reasonable alternative to DCC for term and near term preterm infants with caesarean delivery in regional anaesthesia. The intervention may be especially useful in low-income birth settings with high prevalence of iron deficiency/anaemia and no mobile resuscitation equipment.</p>}},
  author       = {{Sæther, Elisabeth and Andersson, Ola and Myklebust, Tor Åge and Bjellmo, Solveig and Bernitz, Stine and Stridsklev, Solhild and Eriksen, Beate Horsberg}},
  issn         = {{0378-3782}},
  keywords     = {{Caesarean; Delayed cord clamping; Infant; Intact-cord stabilisation; Placental transfusion; Umbilical cord clamping}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Early Human Development}},
  title        = {{Extra-uterine placental transfusion and intact-cord stabilisation of moderately preterm to term infants in caesarean deliveries - A feasibility study with historical control (INTACT-2)}},
  url          = {{http://dx.doi.org/10.1016/j.earlhumdev.2025.106208}},
  doi          = {{10.1016/j.earlhumdev.2025.106208}},
  volume       = {{202}},
  year         = {{2025}},
}