From the Guidelines
The next best step if the umbilical cord is palpated around the neonate's neck during an emergency delivery in the ED is to perform the somersault maneuver immediately. Here's how to do it:
- Gently push the baby's head toward the mother's tailbone (posterior direction).
- Guide the baby to do a forward roll, allowing its chin to tuck to its chest.
- As the body delivers, the umbilical cord should naturally unwind from the neck. If this doesn't work, attempt to slip the cord over the baby's head. Only clamp and cut the cord as a last resort if it's too tight and the baby is in distress. This maneuver is preferred because it's quick, non-invasive, and doesn't risk compromising the cord blood supply, as noted in general medical practice 1. It works by using the baby's own movement to resolve the nuchal cord, which is present in about 25-40% of births and is usually not dangerous if managed properly. Quick action is crucial to prevent potential complications like oxygen deprivation or cord compression. The American Heart Association guidelines focus on neonatal resuscitation and do not specifically address the somersault maneuver, but they do emphasize the importance of prompt action in emergency deliveries 1. Additionally, the guidelines discuss the benefits of delayed cord clamping, but this may not be feasible in emergency situations where the cord is wrapped around the baby's neck 1. In such cases, the somersault maneuver is a practical and effective solution to ensure the baby's safety and well-being.
From the Research
Next Best Steps for Umbilical Cord Palpated Around Neonate's Neck
If the umbilical cord is palpated around the neonate's neck during an emergency delivery in the emergency department (ED), the next best steps are crucial for ensuring the baby's safety and well-being. The following points outline the recommended actions based on available research:
- Do not immediately clamp the cord: Studies suggest that delayed cord clamping (DCC) may be beneficial for the baby, especially in cases where the baby is compromised or asphyctic 2. DCC allows for fetoplacental transfusion of oxygenated venous blood, which may help buffer existing acidosis and enhance blood volume.
- Assess the situation and prioritize the baby's needs: The obstetric and neonatal teams should work together to assess the situation and prioritize the baby's needs. If the baby is vigorous, DCC for at least 2 minutes may be feasible 3. However, if the baby requires respiratory support, the cord should be clamped at least 60 seconds after the colorimetric carbon dioxide detector turns yellow 3.
- Consider the benefits of delayed cord clamping: Delayed cord clamping has been shown to reduce the risk of death before discharge for babies born preterm 4. It may also reduce the number of babies with severe intraventricular haemorrhage (IVH) and chronic lung disease (CLD) 4.
- Be aware of the potential risks of early cord clamping: Early cord clamping may reduce the red blood cells an infant receives at birth by more than 50%, resulting in potential short-term and long-term neonatal problems 5.
- Follow proper clamping techniques: When clamping the cord, it is recommended to clamp at least 5 centimeters from the abdominal wall to avoid iatrogenic clamping of a small unrecognized omphalocele 6.
It is essential to note that the optimal time to clamp the umbilical cord remains unclear, and further research is needed to determine the best approach for each individual situation 4.