Delayed cord clamping is contraindicated in

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Obstetrics & Gynecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2024

Explanation

In Rh-incompatibility, maternal antibodies are present that target and destroy fetal red blood cells (RBCs).
Delayed cord clamping (DCC) increases the volume of placental blood transferred to the newborn, which increases the total number of RBCs.
This larger RBC mass provides more targets for the maternal antibodies, leading to accelerated hemolysis (RBC destruction).
Increased hemolysis worsens neonatal jaundice (hyperbilirubinemia) and anemia, increasing the risk for complications like kernicterus.
Therefore, immediate cord clamping is indicated to limit the amount of blood transfused and reduce the severity of the hemolytic disease of the newborn.

Option A: This is an indication for, not a contraindication to, delayed cord clamping.
Option B: Low birth weight is not a contraindication. Many low-birth-weight infants are preterm, a group for whom DCC is recommended.
Option D: This is a primary indication for delayed cord clamping in infants who do not require immediate resuscitation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Delayed Cord Clamping as background academic context rather than a clinical decision trigger.
Nurses play a crucial role in advocating for the correct cord clamping procedure by being aware of the maternal history, such as Rh status, and the newborn's condition at birth.
In the delivery room, the nurse should anticipate the need for immediate clamping in cases of known Rh-incompatibility or if the baby requires resuscitation, and communicate this with the delivery team.
Patient safety depends on applying evidence-based practices. While DCC is the standard for most births, knowing the specific contraindications like Rh-incompatibility is critical to prevent harm.

How to Approach the Question

First, understand the question is asking for a contraindication, meaning a situation where delayed cord clamping (DCC) should NOT be done.
Recall the basic principle of DCC: it increases blood volume in the newborn by allowing placental transfusion.
Evaluate each option based on this principle. Ask: 'Would increasing the baby's blood volume be harmful in this condition?'
For a baby of an anemic mother, extra blood and iron are beneficial. So, this is an indication, not a contraindication.
For a preterm or low-birth-weight baby, the extra blood volume improves circulation and reduces complications. This is also an indication.
For Rh-incompatibility, recall that maternal antibodies are attacking the baby's red blood cells. More blood means more red blood cells for the antibodies to destroy, which would worsen the condition. This is a clear harm.

Concept Tested & Keywords

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E6 Obstetrics Williams pp. 5-15, 80-95, 15-32