Umbilical clamp

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An umbilical clamp

An umbilical clamp is used when giving birth to children. It serves the umbilical cord before cutting the cord to close so that no infectious agents can penetrate through the umbilical cord, and to avoid bleeding. The clamp is removed 48 to 72 hours later, when the umbilicus has dried up enough to rule out any leakage of blood.

history

Knot used to tie the umbilical cord in a 1910 book

Since the umbilical cord vessels have to transport large amounts of blood during the intrauterine growth of the child, large amounts of blood can escape in a short time if they are injured after birth. In the worst case, the child could bleed to death if it was improperly severed. Even if the umbilical cord is not cut until blood has stopped pulsing, profuse bleeding may occur. This was proven by a study carried out in 1914, in which 1,177 cases of profuse bleeding were registered in over 10,000 births. In order to protect the newborn from harm, the blood supply to the umbilical cord must therefore be cut off before it is cut. This can be done in a variety of ways. In addition, sterile, or at least clean, work is essential to avoid sepsis and umbilical tetanus .

For this purpose, the umbilical cord was already knotted or tied with a ribbon in earlier times. Jean Baptiste Barthélemy de Lesseps reported in 1788 that women's hair was used in Kamchatka . Jakob Ruf shows in his midwifery textbook from the sixteenth century a stitch on which a thread is unwound from a ball of yarn for this purpose. Since the baroque era , richly decorated, non-lockable clamps have also been known, although it is not certain whether they were really used as umbilical clamps or whether they were just works of art as good luck charms. Similar clamps were used later. Since they could not be locked, they were tied together at the handle with a thin thread or a thread was moved over the clamp that opened like scissors. Thin threads could not be used for tying because there was a risk of cutting through the umbilical cord tissue. Around the turn of the century at the beginning of the twentieth century, midwives across Europe had two silk threads or, in poorer areas, two approximately 5 mm wide linen cords in their midwife's case. A book published in 1894 cites the recommendation of Carl Siegmund Franz Credé and others who used elastic ligatures . In his textbook Grundriss for the Study of Obstetrics in 1919, Ernst Bumm recommended linen ribbons that should be soaked in sublimate before use . At that time, sterile ribbons, made of both cotton and silk, were also commercially available in sealed glass tubes that had to break the glass before use. Before the Second World War, Paul Bar invented an umbilical clamp with the current range of functions. This was still made of metal, which was under spring tension and locked automatically when pressed together. At the same time, models with screw caps were also developed.

After the Second World War, the plastic clamps prevailed in the form they are still used today.

Umbilical clamp attached before the umbilical cord

function

Today's umbilical clamps are only suitable for single use. When removing the umbilical cord, the umbilical cord is sterile clamped about 2 cm above the umbilical ring with an umbilical clamp, the locking of which must audibly click into place. The umbilical cord is also clamped in the direction of the placenta , for which purpose medical clamps can be used in addition to umbilical clamps . The umbilical cord is then cut between the clamps with sterile scissors. In sick or premature infants, the umbilical cord is also left longer in order to keep the option of placing an umbilical vein or umbilical artery catheter open. Before the baby is wrapped in warm towels, the midwife must check the fit of the clamp again. If this were not noticed, an inadequately clamped umbilical vessel could result in life-threatening blood loss for the child in a very short time. For umbilical care, the umbilical cord may also be moved with the aid of the clamp. The umbilical clamp is designed in such a way that, once closed, it cannot be opened again without being destroyed. In a trial conducted in 2014 about an umbilical clamp, the unnoticed opening of which had damaged a child's health, a gynecology professor appointed as a reviewer determined that such an unnoticed opening would be an absolutely isolated case for which there is no evidence in the literature.

Veterinary medicine

In animals, the umbilical cord usually breaks when the mother stands up after birth. To protect against infection, pets and farm animals are advised to disinfect them with iodine tincture. The use of an umbilical clamp in horses to stop bleeding is only recommended in exceptional cases. Studies in pig breeding have shown that the use of umbilical clamps does not reduce the number of umbilical infections. There is also no evidence in the literature of a recommendation for use with other pets and farm animals, although some mail-order companies have corresponding clamps on offer.

Web links

Commons : umbilical clamp  - collection of images, videos and audio files
  • www.surgiway.com Webshop with pictures of various umbilical clamps, including a model based on Paul Bar (accessed on November 6, 2014)

Individual evidence

  1. ↑ Mr. G. Schäfer: A new method of cutting the cord . In: Archives for Gynecology . tape 178 , no. 1 , December 1950, p. 319-323 , doi : 10.1007 / BF01090261 .
  2. ↑ Umbilical clamp (1) . Sybodo Museum, accessed November 5, 2014.
  3. ↑ Umbilical clamp (4) . Sybodo Museum, accessed November 5, 2014.
  4. ↑ Umbilical clamp (6) . Sybodo Museum, accessed November 5, 2014.
  5. ↑ Umbilical clamp (4) . Sybodo Museum, accessed November 5, 2014.
  6. ↑ Umbilical clamp (2) . Sybodo Museum, accessed November 5, 2014.
  7. ↑ Umbilical clamp (4) . Sybodo Museum, accessed November 5, 2014.
  8. ↑ Annette Lauber, Petra Schmalstieg: Volume 3: Nursing Interventions . Georg Thieme, 2012, pp. 355–357 ( limited preview in the Google book search).
  9. ^ Dietrich Reinhardt: Therapy of Diseases in Childhood and Adolescence . Springer-Verlag, 2014, p. 5 ( limited preview in the Google book search).
  10. ↑ Annette Lauber, Petra Schmalstieg: Volume 3: Nursing Interventions . Georg Thieme, 2012, pp. 355–357 ( limited preview in the Google book search).
  11. ↑ Midwife sued by health insurance . Abendzeitung München, March 21, 2014, accessed on November 5, 2014.
  12. ↑ Jörg-Eberhard Aurich: Reproductive medicine with horses: Gynecology - Andrology - Obstetrics . Georg Thieme, 2008, p. 199 ( limited preview in the Google book search)
  13. ↑ Mark Pfeifer: Investigations on the etiology of the umbilical hernia in piglets . Dissertation at the Veterinary Faculty of the Ludwig Maximilians University in Munich, 2006 ( online as pdf ).