Prevention of Haemorrhage from the Umbilical Cord.

In December 1962, in the premature nursery of this hospital, a 7-hour-old baby was found dead in a pool of blood which had leaked from the umbilical cord. The baby weighed 4 lb. (1,810 g.) at birth and was under hourly observation by the nursing staff. The cord had been shortened five hours after birth by an experienced staff midwife who had tied a single commercial umbilical tape around it about I in. (3 cm.) from the skin margin, and cut it i in. (1 cm.) from the tape. The baby had appeared well, with normal colour, tone and respirations at the age of 6 hours. When he was found dead it was noted that the ligature was still in place, held by a reef knot sufficiently firmly that it could not easily be pulled off, and that the shed blood contained a number of clots. At autopsy no internal abnormality was revealed. Death appeared to have been due to simple exsanguination through an umbilical cord which had been dealt with in accordance with the routine practice of the hospital. It seemed that there was a need for critical reappraisal of this routine practice.