CA1272929A - Surgical instrument for severing and clamping an umbilical cord - Google Patents

Abstract

ABSTRACT OF THE DISCLOSURE

A surgical instrument for severing an umbilical cord while simultaneously applying a single umbilical cord clamp and compressing the placental (maternal) end of the cord is discussed. The instrument allows release of the hemostat on the maternal end of the umbilical cord immediately after severence of the cord for enabling collection of a blood specimen for a fetal thyroid screen test to avoid discomforting the infant by obtaining the specimen directly from the infant. The instrument includes upper and lower clamping jaws having arranged thereon means for detachably holding an umbilical cord clamp, a blade assembly, and upper and lower hemostat surfaces adapted to compress the umbilical cord when the upper and lower clamping jaws are closed. Further in accordance with the present invention, a generally V-shaped umbilical cord clamp having a pair of arms joined together at an integral hinge and head portions including locking means at the free ends thereof is provided with a channel or opening extending generally diagonally through at least one of the head portions, such channel communicating with the locking means in the head portion to release such locking means when the arms are locked together in clamping position.

Description

SURGICAL INSTRUMENT FOR SEVE~ING AND CL,AMPING AN
UMBILICAL CORD AND CLAMP FOR CLAMPING UM~ILICAL CORD
FIELD OF THE INVENTION

This invention relates toanew surgical instrument for severing an umbilical cord while simultaneously compressing the placental end of the umbilical cord and applying a hemostatic clamp uFon a section of the cord.

BACXGROUND OF THE INVENTION

The umbilical cord is a rope-like structure which connects the ~etus to the placenta. The cord contains two arteries and one vein. The arteries carry blood containing waste products from the fetus to the placenta. The vein carries blood contain-ing oxygen and food substances obtained from the mother's blood back to the fetus.
At the present time, the procedure followed by many obste-tricians following the delivery of the baby, is to clamp two separate hemostats on the umbilical cord at spaced positions and use a pair of sclssors to sever the umbilical cord. Subse~uently an umbilical cord clamp is manually applied to the cord adjacent the baby's navel and a second cutting of the redundant portion of the cord between the clamp and the hemostat is performed.
In recent years various umbilical cord clamping assemblies have been designed to improve and expedite the process of sever-ing the umbilical cord and properly clamping it. An example is in U.S. Patent No. 3,150,666, which shows an instrument ~or clamping one end of the umbilical cord and then applying an elas-tic band around the cord. Another instrument, disclosed in U.S.
Patent 3,166,071, provides means for simultaneously applying two spaced-apart umbilical cord clamps and severing the umbilical cord therebetween. Likewise, U.S. Patent No. 4,428,374 shows an umbilical cord clamping assembly for simultaneously applying a pair of spaced-apart umbilical clamps, connected by a connecting ~.

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~f~7 member. As the clamping tool applies the clamps, it severs both the cord and the connecting member between the clamps.
U.S. Patent 4,026,294 presents another exarnple of a clamping and cutting surgical instrument wherein two umbilical clamps are applied to the cord after which the cord is severed. U.S. Patent No. 3,631,858 shows another simultaneously clamping and severing device including clamping jaws and cutting jaws held together in side-by-side relationship by a web. ~5 the cord is severed and clamped, the web is also severed so that the cutting jaws can be removed while the clamp remains on the cord.
Prior art surgical instruments for clamping and severing an umbilical cord have not gained widespread acceptance. Unfortu-nately, the few seconds wasted by present procedures for severing and clamping the umbilical cord may be the difference between a routine birth or one complicated by serious lung problems in the infant.
It is thus an object of the invention to provide a novel surgical instrument for clamping and severing an umbilical cord, the parts of which are easily manufactured and assembled.
It is also ~n object of the invention to provide a novel surgical instrument for clamping and severing an umbilical cord that will simplify and speed up the operation.
It is another object of the invention to provide a novel surgical instrument for clamping and severing an umbilical cord wherein the instrument applies a single umbilical cord clamp, severs the umbilical cord, and maintains a hemostat on the mater-nal end of the cord.
It is still another object of the invention to provide a novel surgical instrument for clamping and severing an umbilical cord wherein the umbilical cord clamp is detached from the instrument without opening its clamping jaws.

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It is a further object of the invention to provide a novel surgical instrument for clamping and severing an umbilical cord which includes a single-use, disposable blade assembly It is still another object o~ this invention to provide an umbilical cord clamp which can be readily detached from the umbilical cord portion attached to the infant without the need for severing the clamp at its hinge portion.

SUMMARY OF THE INVENTION
Applicant's novel surgical instrument for clamping and severing an umbilical cord provides many benefits such as hasten-ing the availability of the newborn child for inspection to reduce the risk of fetal aspiration. A major concern is meconium (fetal bowel movement) aspiration leading to pulmonary complica-tlons. Maternal blood and amniotic fluid aspiration are of a lesser concern. It is believed that the known procedures requir-ing 6-7 seconds for severing the cord could be reduced to 2-3 seconds with the present invention. Thus the infant's attendant who is to perform direct tracheal suctioning,is provided with an opportunity to suction the infant's air passages possibly before the infant's first breath or, at least before its second breath, to prevent material from reaching far into the bronchi.
Applicant's novel surgical instrument and the manner in which it is used shall now be described. The surgical instrument initially would be loaded with an umbilical cord clamp and a new blade assembly. ~s the obstetrican delivers the baby, he would cradle the baby in one arm while simultaneously picking up the loaded instrument with the other arm. The upper and lower jaws of the instrument would be placed in contact with the baby~s umbilical cord adjacent its navel and a clamping action would be performed. At the completion of the clamping stroke, the umbili-cal cord clamp remains locked on the baby's umbilical cord adja-. .

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cent its navel while the remainder of the umbilical cord is severed therefrom. Particular movemen of the surgical instru-ment, as by hand, detaches the umbilical cord clamp from the surgical instrumen~ ~ithout opening the instrument's clamping ja~s, while the hemostat surfaces of the surgical instrument maintain a tight clamping action on the maternal end of the umbilical cord. After this clamping and severing procedure, the baby would be handed to the infant's attendant for immediate, direct trachael suctioning. Clamping by the hemostat surfaces on the maternal end of the cord could then be released just long enough to collect a blood specimen for a fetal thyroid screen test. The hemostat surfaces would then b~ reclamped with the redundant cord rolled about ~he instrument with gentle traction applied to enhance the delivery of the placenta rom the mother.
Thus the surgical instrument of the present invention replaces the two hemostats and scissors previously needed. Fur-ther, since the instrument of the present invention requires only one severence of the cord, the risk of innoculating exposed blood vessels in the cord with infected amniotic fluid is reduced.
Finally, since the instrument in accordance with the present invention provides means to sever and clamp the cord in very close proximity to the infant, it obviates conventional proce-dures requiring a scrub nurse to hand sterile scissors to an often ungloved attendant to trim and clamp ~he redundant cord.
The use of gloves by an attendant is discouraged because they make it difficult to catch the wet baby and to perform trachael suctioning on the baby. The use of conventional procedures expose the attendant's hands to blood from the severed cord while performing such trimming and clamping. Obviating such conven-tional procedures is now especially important in view of the present threat of hepatitis and/or AIDS.

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Further in accordance with the present invention, a generally V-shaped umbilical cord clamp assem~ly formed of a ~lexible material having a pair of arms preferably joined together at an integral hinge and head portions including releasably locking means at the free ends thereof. Such clamp provided with a channel or opening extending generally diagonally through at least one of the head portions, such channel com-municating with the locking means in the head portion to release such locking means when the arms are locked together in clamping position. Said umbilical cord clamp appliable by compressive force exerted by the jaws of a scissor-like surgical instrument. In a preferred embodiment said clamp releasably locking in the clamping position, whereby the compressive force moves said arms toward each other whereupon said locking means locks free ends together.

In this divisional specifiaation the present invention provides a scissor-like surgical instrument including handle portions and first and seoond closing jaw portions attached thereto for simultaneouæly severing an umbilical oord, compressing the placental end of the cord, and applying an umbilical clamp about a section of the cord, said instrument comprising: a~first hemostat surface unreleasably affixed to said first jaw; a second hemostat surface unreleasably affixed to said second jaw, æaid hemostat surfaces adapted to compress the umbilical cord therebetween upon closure of said jaws and to release the cord upon opening of said jawæ; cutting means disposed upon one of sald ~aws for severing the umbiliaal cord upon closure of said jaws; and coupling means on at least one of said jaws for releasably coupling with corresponding coupling means on the umbilicsl clamp.

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DESCRIPTION OF THE DRAWINGS
Figure 1 is a side elevational view of a surgical instrument for clamping and severing an umbilical cord in accordance with the present invention;
Figure 2 is a partial side elevational view of the instru-ment of Figure 1 with the blade assembly removed;
Figure 3 is a side elevational view of a blade assembly . suitable for use with the surgical instrument of Figure l;
Figure 4 is a side elevational view of a first embodiment of an umbilical cord clamp in accordance with the p~esent invention;
Figure 5 is an end elevational view of the umbilical cord clamp of Figure 4 in its closed position;
Figure 6 is a cross-sectional view taken along line 6-6 of Figure 4 illustrating the initial engagement of the lower clamp-ing jaw of the instrument with the clamp;
Figure 6a is a cross-sectional view taken along line 6-6 of Figure 4 and illustrates the mating of the lower clamping jaw of the instrument with the clamp once the upper and lower clamping jaws have been closed;
Figure 7 is a bottom plan view taken along line 7-7 of Figure 4;
Figure 8 is an end elevational view taken along line 8-8 of Figure 2;
Figure 9 is a cross-sectional view taken along line 9-9 of Figure 3;
Figure 10 is an end elevational view of the blade assembly of Figure 3;
` Figure 11 is a partial front elevational view of the blade assembly of Figure 3;
Figore 12 is an end elevational view taken along line 12-12 of Figure~2;

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2~3 : Figure 13 is a top plan view of the upper clamping jaw of the instrument of Figure 1 with the ~op portion of the umbilical cord clamp shown as loaded therein;
Figure 14 is a side elevational view of the upper clamping jaw of Figure 13 with the top arm of the umbilical cord clamp shown as inserted therein;
Figure lS is a side elevational view of a first alternative embodiment of an umbilical cord clamp in accordance wi~h the present invention;
Figure 16 is a partial side elevational view of a first alternative embodiment of a surgical instrument in accordance with the present invention;
Figure 17 is a perspective view o a second alternative embodiment o~ an umbilical cord clamp utilized with the instru-ment illustrated in Figure 16;
Figure 18 is a perspective view of a blade assembly utilized with the instrument illustrated in Figure 16;
Figure 19 is a top plan view of the blade assembly illu-strated in Figure 18;
Figure 20 is an elevational view taken along line 20-20 of Figure 16;
Figure 21 i9 an elevational view taken along line 21-21 of Figure 16;
Figure 22 is an exploded, perspective view showing a second alternative embodiment of a surgical instrument including coupl-ing means and a clamp having corresponding coupling means for engaging the instrument in accordance with the present invention;
; Figure 23 is a ront sectional view of the jaws of the instrument of Figure 22;
Figure 24 is a perspective view of a third alternative embodiment of an umbilical cord clamp in accordance with the present invention and :,,. :
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Figure 25 is a perspective vie~J of a fourth alternative embodiment of an umbilical cord clamp having rounded arms and head portions and an opening therethrough in accordance with the present invention.

DESCRIPTION OF THE PREFERRED EMBODIMENT
A first embodiment of a surgical instrument ror severing an umbilical cord will be described with reerence to Figures 1-19. The surgical instrument is generally designated by numeral 20. It has a pair of elongated handles 21 and 22 that are pivoted with respect to each other around a pivot pin 24. An upper clamping jaw 26 is formed on the free end of handle 22 and a lower clamping jaw 27 is formed on the free end of handle 21.
Finger gripping members 28 and 29 are formed on the ends of the respective handle members 21 and 22. The length of handles 21,22 in combination with finger gripping members 28,29 provides sufficient leverage to sever the umbilical cord in a single clamping motion. To lock jaws 26 and 27 in place, extensions 31 and 32 are provided. Extensions 31 and 32 have corresponding buttress-teeth 35 and 36, which teeth mate to lock handles 21 and 22 in a particular position.
Surgical instrument 20 may be made of any suitable material, but preferably would be made from stainless steel. A disposable model, however, preferably would be made from a plastic material.
Removable blade assembly 40 is best illustrated in Figures

3, and 9-11. Blade assembly 40 has an elongated blade member 41 having a front surface 42, a rear surface 43, and a bo~tom cutting edge 44. A support member 46 having a T-shaped cross-sectional configuration is secured to the rear surface by means such as rivets 48 shown in Figure 3. A finger gripping member 49 is formed on one end of support member 46 to aid in removing blade assembly 40 from upper clamping jaw 26. Where surgical :. , , ~ ' '; - ' ~'7~
instrument 20 i5 of the disposable type, the blade assernbly may be permanently secured to jaw 26 rather than being removable.
The manner in which blade assembly 40 is supported in upper clamping jaw 26 is best understood by referring ~o Figures 2, 8 and 9. As shown in those figures, upper clamping jaw 26 has an exterior wall surface 51, an interior wall surface 52, and an upper hemostat surface 53. An open ended slot 55 has a T-cross-sectional configuration that matingly receives T-shaped support member 46 on the rear of blade 41. Alternatively, the blade assembly may be supported by the lower clamping jaw in a manner similar to that described above.
Umbilical cord clamp 60, ideally suited for use with surgi-cal instrument 20, is illustrated in Figure 4. Clamp 60 has an upper arm 61 having a front end 62 and a rear end 63. It also has a lower arm 64 having a front end 65 and a rear end 66. Rear ends 63 and 66 are connected together by integral hinge portion 68. Upper arm 61 also has teeth 70 on its lower surface and a head portion 71. Lower arm 64 has teeth 73 on its top surface and further includes an umbilical cord blocking member 74 and a head portion 75. The manner in which head portion 71 of upper arm 61 and head portion 75 of lower arm 64 clamp together is illustrated in Figure 5. A tongue portion 77 is formed on head portion 75 and it is clamped into groove 78 by resilient flanges 79 and 80 formed on the bottom of head portion 71.
Upper arm 61 and lower arm 64 have similar corresponding structure for detachably securing or coupling them to the re~pec-tive upper and Iower clamping jaws 26 and 27. Figures 6 and 6a along with Figures 8 and 12 aid in understanding the detachable securing or coupling of arms 61 and 64 with jaws 26 and 27. As seen in Figure 8, upper clamping jaw 26 has a channel 84 formed by interior wall surface 52. Upper arm 62 of umbilical clamp 60 . .: :. .
, .. ~ , - , , nests in channel 84 and attaches to upper jaw 26 by means of neck member 86 and tongue portion 87 that extend into the mating structure, discussed infra, on the top of head portion 71. This mating relationship will be described with respect to the similar mating or coupling structure included in lower clamping jaw 27, as illustrated in Figures 6, 6a and 12.
As seen from Figure 12, lower clamping jaw 27 has an exter-ior surface 90, an interior wall surface 91, and a lower hemostat surface 92. A channel 94 is formed by interior wall surface 91. A neck member 96 extends upwardly from channel 94 and includes a tongue portion 97 on its top end Figure 6 illustrates the initial loaded position of lower arm 64 of umbilical clamp 60 and its manner of attachment to tongue portion 97 of lower clamping jaw 27~ Head portion 75 has a primary groove 100 formed in its bottom surface which matingly receives tongue 97 of lower clamping jaw 27. As the upper and lower clamping jaws 26 and 27 are firmly clamped about the umbil-ical cord, tongue 97 is driven into secondary groove 102. Since the dimensions of secondary groove 102 are larger than those of tongue 97, tongue 97 is freely movable within the constraints of secondary groove 102. ~hus surgical instrument 20 may be pulled away from umbilical cord clamp 60 once clamp 60 has been clamped to the new born baby adjacent the navel area.
Fiqure 7 is a bottom plan view which further aids in under-standing the configuration of primary and secondary grooves 100 and 102 in the bottom of head portion 75. Similar primary and secondary grooves are found in the top surface of head portion 71 of upper arm 61. Figures 13 and 14 illustrate clamp 60 attached to the upper clamping jaw 26.
While clamp 60 is securely coupled to both jaw 26 and 27 by means of tongues and prlmary and secondary grooves as discussed, _ g _ .
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other coupling arrangements are possible, ~or e~ample, only one of the opposing jaws and one of the upper and lower arms need include the mating tonyue and yroove means discussed u~. In such an embodiment, such coupling means could be included on either the upper or the lower jaws and such correspondiny coupliny means could likewise be included on either the upper or the lower arm.
A first alternative umbilical cord clamp 60a is illustrated in Fiyure 15 and has longer primary and secondary grooves shown in broken lines as extending alony the respective upper and lower arms.
A modified suryical instrument 120 is illustrated in Fiyure 16. Instrument 120 utilizes an umbilical cord clamp 160 and a blade assembly 140, shown respectively in Figures 17 and 18, and shown as assembled in the top plan view of Figure 19. Cord clamp 160 has an upper arm 161 and a lower arm 164 connected by integral hinge portion 168. Head portion 171 has a groove 178 defined by resilient flanges 179 and 180. Head portion 175 has a similar tongue configuration 177 that matingly engages groove 178 when upper and lower arms 161 and 164 are clamped together about an umbilical cord.
In the embodiment of Figures 16-21, upper arm 161 of clamp 160 has a protrusion 200 extending upwardly from its top surface to be matingly received in a recess 201 formed in channel 184 of upper clamping jaw 126, as shown in Figure 20. Likewise, the lower arm 142 of blade assembly 140 has a protrusion 200 extendiny downwardly that mates in recess 201 formed in channel 194 of lower clamping jaw 127, as shown in Figure 21. Eliminated in this version are the respective neck members and tongue portions of the first embodiment of the instrument and clamp of the invention.

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Blade assemDly 140 attaches to cord cIamp lbO by a pair of pop beads 210 that mate in recesses 212 of the blade assembly.
In operation, clamp 160 and blade assemply 140 are snapped together and then loaded into surgical instrument 120. ~he action of closing clamping jaws 126 and 127 and thu~ severing the umbilical cord will either cause blade 141 to ~urther sever pop beads 210 from lower arm 164 or wedge blade 141 between assem-blies 140 and 160 so tha~ beads 210 are pulled from engagement with recesses 212. In either event, clamp 160 and blade assembly 140 become separa~2d when ~he cord clamp 160 is locked into en-gagement around the umbilical cord. The surgical instrument then can be removed by 6napping ~he protrusion 200 ou~ of recess 201.
Figure 22 shows ~n exploded view a third embodiment o~ a surgical instrument 300 along with a ~lamp 302 ideally suited for use with instrument 300, wherein different means for coupling the clamp to the instrument are utilized. Instrument 300 likewise includes scissor-like handles 304 and closing upper and lower jaws 306, 308.
Upper jaw 306 includes a hemostat surface 310 and a blade assembly 312. It ls to be understood that blade as~embly 312 ~ay be either permanently or replaceably mounted on jaw 306. Upper jaw 306 further includes longitudinally extending c~nformed slot 314. Lower jaw 308 likewise includes a hemostat surface 316, an anvil section 318 prov~ding a ~olid cutting ~urface for blade 312, and ~ouplin~ means 320. As seen from Figures 22 and 23, coupling means 320 generally comprises longitudinally extending slot 322 ha~ing ~n enlarged forward section 324. Opposlng flanges 326 extend horizon~ally inwardly from t~e ~de walls of forward ~ection 324.
As shown i601ated from contact with instrument 300 in Figure ~2, clamp 302 is of ehe V-shaped ~ype generally having spac~d ~ .' ,.; . ~ ~' .
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apart upper and lower arms 328 and 330 which are joined together at one end by flexible hinge portion 332. Head portions 334 and 336 are respectively integrally joined with arms 328 and 330 at the free ends thereof. Clamp 302 is also provided with blocking member 331 which prevents the umbilical cord from entering the open area defined by the hinge portion 332.
Lower arm head portion 336 includes corresponding coupling means generally indicated by reference numeral 33~. In particu-lar, corresponding coupling means 338 includes a pair of longi-tudinal, spaced-apart ridges 340 on each side of head portion 336, to define a groove 342 therebetween.
Thus instrument 300 is adapted to slidably receive clamp 302 by sliding lower arm 330 rearwardly into slot 322 of lower jaw 308. As lower ~aw 308 engages hinge 332 and lower arm 330, coup-ling means 320 interlocks with corresponding coupling means 338 as grooves 342 receive flanges 326. Slot 314 is configured to receive upper arm 328 and head portiorl 334 therein whén clamp 302 is loaded into instrument 300. When so interlocked, coupling means 32Q and corresponding coupling means 338 provide for suffi-ciently tight engagement therebetween to prevent clamp 302 from falling from instrument 300 when in use. However, means 320 and 338 do not engage so forceably as to inhibit free release of clamp 302 from instrument 300 by rearward movement of the instru-ment once clamping about the umbiIical cord has been accomplished.: :
It will be appreciated that the coupling means above described with respect to the lower jaw of the instrument and the lower clamp could just as readily be placed on the upper jaw of ; the instrument and upper arm of the clamp, or even on both jaws and both arms, as desired.

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It will be appreciated that the outer surfaces of at least one head portion of the clamp can be made of the same dimensions as the cavity 326 of the jaw shown in Figure 22 and a horizontal groove can be formed on each side of the clamp head portion to snugly engage opposing flanges or ribs 326 so as to hold the clamp 302 with the instrument until the clamping procedure is completed, which procedure includes the simultaneous severing of the umbilical cord and the compressing of the placental end of the cord by the hemostate surfaces of the instrument. This modification obviates the need for forming the spaced-apart ridges 340 to define the grooves or indents since such grooves can be formed within the sides of the head portions of the clamps.
In still another embodiment of the clamp illustrated in Figure 22 slot 322 which extends to the front of the instrument 300 is made deeper. Lower arm head portion 336 is provided with grooves 342 on either side thereof which initially engage ridges 326 and is further provided with a slightly larger groove formed parallel to and slightly above each of grooves 342. When the clamp 302 is placed within the instrument 300 so that grooves 342 engage ridges 326, the base of head portion 336 is spaced from the bottom of slot 322. Upon tigh~ closure of the clamp whereby tongue 344 engages and is locked into the upper arm head portion and is held by the flanges 348, the lower arm head portion is forced downwardly into slot 322 as grooves 342 are forced past ridges 326, Ridges 326 now~exte~d into the larger parallel grooves (not shown) directly above grooves 342. Because the ridges more loosely fit into the larger grooves, the locked clamp is more easily withdrawn f,rom the instrument.
Alternative locking means for locking the upper and lower heads of the clamp when it is clamped about the umbilical cord ' ~ .
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are also shown in Figure 22. These include tonyue 344 integral with and extending ~pwardly from the end o~ head portion 336 and adapted to snap into recess 346 ~ormed by resilient flanges 348 in head portion 334, which flanges spread outwardly a sufficient distance to permit tongue 344 to enter recess 346 before return-ing ~o their normal position. Of course, the tongue can be pro vided on the upper head and the recess on the lower head of the clamp, if desired.
Clamping and severing instrument 300 can be further modified by making hemostat surfaces 310, 316 smooth instead of serrated and fastening a semi~rigid flexible plastic strip over each of such flat surfaces, such strip surfaces having the configuration of a hemostat surface, such as serration. If desired, the strip fastened to the smooth upper hemosta~ surface in the upper jaw of the ins~rument, whose hemostat surface 310 is now shown in Figure 22, could have a thlckness of the height of the exposed blade 315 and thus simultaneously act as a guard to the blade.
Alternatively, such flexible plastic hemostat strips could be secured at their ends to the instrument above the smooth surfaces (where surfaces 310 and 316 now appear) and have their body portions spaced slightly above such surfaces. In this manner, the flexible plastic strips provide a variable compliance for thick versus thin umbilical cords being severed and clamped at the placental end of the cord. The l'give" of the flexible plastic strips as they are compressed about the umbilical cord would depend on tbe size of the cord. The flexible plastic strip on the upper clamping jaw of the instrument spaced from smooth surface 310 would also act as a guard for the blade 315. Such plastic strips could be on either or both clamping jaws of the instrument to form one or a pair of hemostat surfaces. If on one surface of the in~trument, then the other clamping jaw of the ~: , ...
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instru~ent would be p~ovided with hem~stat surfaces 310 ~r 316, as shown in Fig~re 22.
When it is time to remove the clamp from that portion of the umbilical cord attached to the infant, the most com~on procedure is to sever the clip at the hinge portion 68, 168, 332 since it is extremely difficult to separate the head portions of the clamp after they have been closed and locked. This means that clippers must always be available in order to sever the clamp at the hinge and remove it from the infant.
As illustrated in Figure 22, the head 334 on the upper arm 328 is provided with an opening 350 extending from the upper s~rface of the head and communicating with the recess or cavity 346. When clamp 302 is locked and tongue 314 is disposed within recess 346, the tongue deflnes an axis, and, opening 350 and thus the walls 351 thereof are inclined with respect to the axis of the ton~ue. Tongue 314 is prevented from being with-drawn by the presence of flanges 348. A thin rigid rod or probe is inserted through the opening 3~0 to push against the tongue 314 in recess 346 and force the flexible tongue out of recess 346, thus disengaging the locking mechanism and separating the heads 334, 336 due to the inherent spring resiliency in the plastic structure of flexible hinge 332. The clamp is then easily removable ~rom the umbilical cord.
Figure 24 illustrates a modified embodiment of the clamp of Figure 22. ~ead portion 334 defines the recess or cavity 346 therein b~t instead of the pair of flanges 348 which lock ~he tonque within the recess, as shown in Figure 22, the undersurface 352 of the head 334 is provided with a narrow neck portion 354 adapted to engage the neck portion 356 of flexible tongue 344 formed by notches 358. A pair of projections 360 (only one shown) extend vertically within recess 346. When the clamp of Figure 24 is closed, flexible tongue 344 enters cavity 346 with the neck 356 of the tongue disposed within neck portion 354 and ~2 99~

the tongue is held within the cavity behind the pair o~ projec tions 3S0. To unl~ck the clamp, a probe, ~hown generally ~y instrument 362, having a narrow tip portion 364, may be extended into recess 350 to rele~se tongue 344 by pushing tonyue 344 and thus notches 358 outwardly away from engagement with projections 360 in opening 346. Once tongue 344 is pushed aw~y fzom contact with projections 360 by instr~ment 362, clamp 302 pOp5 open due to the inherent spring resiliency in the plastic structure of flexible hinge 322.
It will be apparent that the opening 350 m~y be o~ suffi-cient diameter to admit any of a wide variety of medical inRtru-ments which are at hand or available to the nurse or doctor at the time the clamp is to be removed from the portion o~ the umbilical cord still attached to the infant. The walls 351 of the opening likewise could have varying degrees of curvature for admitting instruments having an accurate shape. The clamps according to the pres~nt inventio~ have an opening such as exemplary opening 350 in at least ~ne of the arms thereof; either of the arms can have such an opening in their head portions.
Figure 25 shows ~tlll another embodiment of an umbilical clamp 500 in ~ccordance ~ith the present invention. Clamp 500 is alsc o the V-shaped v~ri~ty and has rounded arms 502, 504 ~nd round~d head portions 506 and 508. The ~urved or rounded confi-guration of clamp 500 ensures against abrading or cutting of the infant's skin af~er the clamp has been att3ched adjacent the infant's navel area~
Clamp 500 l~ewise lncludes an opening or channel 510 for pelmitting facilitated release of the arms of the cla~p. Channel 510 opens ~t the top of rounded head portion 506 ~nd has walls extending diagonally therethrough to communicate with a locking device 512 compri6ing recess 514 and tongue 516. Tongue 516 engages within recess 514 in any manner now well understood by those skilled in the ~rt. Thus, upon closure o~ clamp 500, a similar probe (not shown) ~ay be extended through channel 510 into recess 514 t~

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~ 2$1Z~3 disengage tongue 516 and thereby release clamp 500. Preferably, clamp 500 also includes corresponding coupling means ~not sho~n) making clamp 500 suitable for use with an instxumen~ of the type illustrated in Figure 1.
It will. also be appreciated that clamp 500 can be provided with groove 518 on either side of bottom head portion 508 for engaging the corresponding ridges 326 on instrument 300 illustrated in Figure 22. ~s explained above, if slot 322 which extends to the front of the instrument 300 is made sufficiently deep then when clamp 500 is inserted therein, ridges 326 will ride in grooves 518 and the bottom of the clamp will be spaced above the bottom of the slot. By applying closing pressure on the clamp by the instrument tongue 516 will enter recess 514 and be locked therein while simultaneously applying sufficient pressure to the bottom clamp head 508 ~o force the ridges 326 upwardly out of the groove 518 and into either a larger groove (not shown) directly above and parallel to each of grooves 518, or into the space above the groove 518 and its laterally extending ledge or ridge portion 520, so as to more readily facilitate removal of the closed clamp from the instrument 300.
~ lthough the present invention has been described with reference to pre~erred embodiments, other modifications and arrangements could be made within the scope of the disclosed invention.

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Claims (11)

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

1. A scissor-like surgical instrument including handle portions and first and second closing jaw portions attached thereto for simultaneously severing an umbilical cord, compressing the placental end of the cord, and applying an umbilical clamp about a section of the cord, said instrument comprising:
a first hemostat surface unreleasably affixed to said first jaw;
a second hemostat surface unreleasably affixed to said second jaw, said hemostat surfaces adapted to compress the umbilical cord therebetween upon closure of said jaws and to release the cord upon opening of said jaws;
cutting means disposed upon one of said jaws for severing the umbilical cord upon closure of said jaws; and coupling means on at least one of said jaws for releasably coupling with corresponding coupling means on the umbilical clamp.

2. The scissor-like surgical instrument as claimed in claim 1 wherein said cutting means comprises a blade assembly mounted to one of said jaws, said blade assembly including a rear support member, one of said jaws including an open slot for slidably receiving said support member therein.

3. A surgical instrument as claimed in claim 2 wherein said blade assembly comprises an elongated blade having a finger grip member thereon.

4. The scissor-like surgical instrument as claimed in claim 1 wherein said corresponding coupling means on the umbilical clamp includes a primary groove and a secondary groove formed in the clamp, said coupling means on said at least one jaw further comprising a flexible tongue portion for extending into said primary groove when said jaws are in an open position, said tongue portion extending into said secondary groove upon closure of said jaws about the cord, said primary groove being of substantially the same dimensions as said tongue, said secondary groove being of larger dimensions than said tongue.

5. The scissor-like surgical instrument as claimed in claim 1 wherein said corresponding coupling means on the umbilical clamp includes at least two ridges and at least one indent or groove therebetween, said coupling means on said at least one jaw further comprising a longitudinal slot for slidably receiving the clamp, said slot having a pair of inwardly extending flanges for slidably engaging said indent or groove between said ridges.

6. A surgical instrument as claimed in claim 1 further comprising means for releasably locking said handle portions together to releasably compress the placental end of the umbilical cord between said hemostat surfaces.

7. In combination with a generally V-shaped umbilical cord clamp fabricated of flexible material and formed by a pair of arms joined together at the apex of the V by an integral hinge-forming loop of substantial diameter, the free ends of the arms terminating in head portions being normally spaced apart, said arms being movable toward each other by a compressive force to clamp an umbilical cord therebetween, said head portions carrying means for locking the arms together in clamping position, at least one of said head portions having coupling means on its outer surface, a surgical instrument for simultaneously severing the cord, clamping a portion of the cord with said clamp and compressing the placental end of the cord to prevent the flow of cord fluid therethrough comprising:
first and second jaws pivotally connected together in scissor-like manner, said jaws including a first hemostat surface unreleasably affixed on said first jaw and a second hemostat surface unreleasably affixed to said second jaw, said hemostat surfaces compressing the placental end of the cord to prevent the flow of cord fluid upon closure of said jaws and releasing the cord upon the opening of said jaws;
a blade assembly removably attached to one of said jaws for severing the cord; and coupling means on at least one of said jaws for releasably coupling with said coupling means on at least one of said head portions of said V-shaped clamp.

8. A surgical instrument as claimed in claim 7 further comprising means for releasably locking said handle portions together to releasably compress the placental end of the umbilical cord between said hemostat surfaces.

9. The combination as claimed in claim 7 wherein said coupling means on said at least one head portion of said clamp includes a primary groove and a secondary groove formed therein, said coupling means on said at least one jaw further comprising a tongue portion, said tongue portion extending into said primary groove when said jaws are in the open position and said tongue portion extending into said secondary groove upon closure of said jaws about said umbilical cord, said primary groove being of substantially the same dimensions as said tongue, said secondary groove being larger than said primary groove.

10. The combination as claimed in claim 7 wherein said coupling means on said at least one head portion includes at least two ridges and at least one indent or groove therebetween, said coupling means on said at least one jaw further comprising a longitudinal slot for slidably receiving said at least one arm and head portion having said coupling means, said slot having a pair of inwardly extending flanges for slidably engaging into said indent between said ridges and securely holding said clamp within said instrument.

11. A scissor-like surgical instrument including handle portions and first and second closing jaw portions attached thereto for releasably compressing the placental end of the cord and applying an umbilical clamp about a section of the cord without releasing compressive force on the placental end of cord, said instrument comprising:
a first hemostat surface on the first jaw;
a second hemostat surface on the second jaw, said hemostat surfaces adapted to compress said umbilical cord therebetween upon closure of said jaws;
coupling means on at least one of said jaws for releasably coupling with corresponding coupling means on the umbilical clamp, said corresponding coupling means on the umbilical clamp including a primary groove and a secondary groove formed in the clamp, said coupling means on said at least one jaw including a flexible tongue portion for extending into said primary groove when said jaws are in an open position, said tongue position extending into said secondary groove upon closure of said jaws about the cord, said primary groove being of substantially the same dimensions as said tongue, said secondary groove being of larger dimensions than said tongue;

locking means for releasably locking said handle portions together to compress the placental end of the umbilical cord between said hemostat surfaces; and a blade assembly disposed upon one of said jaws for severing the cord upon closure of said jaws.