A Case of Severe Infant-to-Placenta Hemorrhage in Association with Prolonged Delayed Cord Clamping

Patient: Male, newborn Final Diagnosis: Hemorrhage Symptoms: Hemorrhagic shock • respiratory distress Medication: — Clinical Procedure: Blood transfusion • CPAP treatment • head scan • saline bolus Specialty: Pediatrics and Neonatology OBJECTIVE: Unusual clinical course BACKGROUND: Delayed cord clamping is a well-established and evidence-based clinical practice which has improved the outcomes of many infants. Because of the positive effects of delayed cord clamping, non-evidence-based practices, including delaying cord clamping for up to 1 h until complete non-severance of the placenta, are becoming more widespread. CASE REPORT: A full-term infant, born vigorous and well at a hospital, was hypotonic and poorly perfused at 50 min of age. Lab tests at 2 h of age showed metabolic acidosis with a pH of 6.95 and base excess of −18. The hemoglobin level decreased from 226 g/L in the umbilical cord at birth to 108 g/L in the infant at 12 h of age. Infection, cardiac malformation, and internal hemorrhage were ruled out. Review of the perinatal history revealed the cord was deliberately not clamped until the infant was about 50 min old and the placenta was placed below the level of the child during this time. The infant was considered to have lost a large volume of blood into the placenta, causing a hypovolemic shock. CONCLUSIONS: Different medical societies recommend delayed cord clamping from at least 30 sec up to 3 min, and there is no evidence of additional benefits after the placenta has been delivered and cord pulsations have ceased. This case report shows that extremely late cord clamping can be acutely dangerous to the infant. It is important to discourage from this practice, and if parents reject cord clamping, the positioning of the placenta may be important.