Impact of early versus delayed umbilical cord clamping on post partum blood loss: a randomized controlled trial (original) (raw)
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JAMA
recommends a delay in umbilical cord clamping in term neonates for at least 30 to 60 seconds after birth. Most literature supporting this practice is from low-risk vaginal deliveries. There are no published data specific to cesarean delivery. OBJECTIVE To compare maternal blood loss with immediate cord clamping vs delayed cord clamping in scheduled cesarean deliveries at term (Ն37 weeks). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial performed at 2 hospitals within a tertiary academic medical center in New York City from October 2017 to February 2018 (follow-up completed March 15, 2018). A total of 113 women undergoing scheduled cesarean delivery of term singleton gestations were included. INTERVENTIONS In the immediate cord clamping group (n = 56), cord clamping was within 15 seconds after birth. In the delayed cord clamping group (n = 57), cord clamping was at 60 seconds after birth. MAIN OUTCOMES AND MEASURES The primary outcome was change in maternal hemoglobin level from preoperative to postoperative day 1, which was used as a proxy for maternal blood loss. Secondary outcomes included neonatal hemoglobin level at 24 to 72 hours of life. RESULTS All of the 113 women who were randomized (mean [SD] age, 32.6 [5.2] years) completed the trial. The mean preoperative hemoglobin level was 12.0 g/dL in the delayed and 11.6 g/dL in the immediate cord clamping group. The mean postoperative day 1 hemoglobin level was 10.1 g/dL in the delayed group and 9.8 g/dL in the immediate group. There was no significant difference in the primary outcome, with a mean hemoglobin change of −1.90 g/dL (95% CI, −2.14 to −1.66) and −1.78 g/dL (95% CI, −2.03 to −1.54) in the delayed and immediate cord clamping groups, respectively (mean difference, 0.12 g/dL [95% CI, −0.22 to 0.46]; P = .49). Of 19 prespecified secondary outcomes analyzed, 15 showed no significant difference. The mean neonatal hemoglobin level, available for 90 neonates (79.6%), was significantly higher with delayed (18.1 g/dL [95% CI, 17.4 to 18.8]) compared with immediate (16.4 g/dL [95% CI, 15.9 to 17.0]) cord clamping (mean difference, 1.67 g/dL [95% CI, 0.75 to 2.59]; P < .001). There was 1 unplanned hysterectomy in each group. CONCLUSIONS AND RELEVANCE Among women undergoing scheduled cesarean delivery of term singleton pregnancies, delayed umbilical cord clamping, compared with immediate cord clamping, resulted in no significant difference in the change in maternal hemoglobin level at postoperative day 1.
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Immediate cord clamping (ICC), a fairly new birth practice, is a common routine practice in hospital settings throughout the world, replacing the decade long older practice of delayed cord clamping (DCC). A delay in clamping the cord facilitates a gentle physiologic transition that benefits all neonates, especially to the vulnerable ones, resulting in increased infant's hemoglobin and hematocrit levels. Objective: To determine the effect of timing of cord clamping on hemoglobin and hematocrit levels in preterm deliveries. Materials and Method: This was a hospital based prospective cohort study conducted in the department of Obstetrics and Gynecology, JNMC, Aligarh. A total number of 150 cases of preterm deliveries were included, which were randomly allocated to umbilical cord clamping done at<30 seconds i.e. Group A (50 cases), delayed cord clamping done at 60-120 seconds i.e. Group B (50 cases) and delayed cord clamping done at >180 seconds i.e. Group C (50 cases). Hemoglobin and hematocrit levels were assessed at birth, at 24 hours after birth and at discharge. Analysis was done using t-test, chi-square test and ANOVA test (Analysis Of Variance). Results: Mean hemoglobin and hematocrit levels at birth, 24 hours after birth and at discharge were significantly higher in the delayed cord clamped neonates as compared to the early clamped group. There was a significant rise in mean hemoglobin level in the delayed clamped group B (0.9±1.55 g/dl) and group C (1.82±1.68 g/dl) as compared to the early clamped group A, in which there was a reduction of 0.46 ± 1.66 g/dl, in hemoglobin levels. Statistically insignificant rise in mean hematocrit level was observed in delayed clamped group B (2.21 ± 2.97 %) and group C (1.24±3.22%), as compared to group A (1.41± 6.72%). Conclusion: Delayed cord clamping is associated with higher hematocrit and hemoglobin levels at birth, at 24 hours and at discharge in preterm deliveries. This is a low cost intervention and its implementation would be particularly relevant in under-resourced settings, where anemia is still a major challenge.
Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal
BMC research notes, 2018
Delayed umbilical cord clamping (DCC) (≥ 60 s) is recognized to improve iron status and neurodevelopment compared to early umbilical cord clamping. The aim of this study is to identify current umbilical cord clamping practice and factors determining the timing of clamping in a low-resource setting where prevalence of anemia in infants is high. A cross-sectional study design including 128 observations of clinical practice in a tertiary-level maternity hospital in Kathmandu, Nepal. Overall 48% of infants received DCC. The mean and median cord clamping times were 61 ± 33 and 57 (38-79) s, respectively. Univariate analysis showed that infants born during the night shift were five times more likely to receive DCC (OR 5.6, 95% CI 1.4-38.0). Additionally, infants born after an obstetric complication were 2.5 times more likely to receive DCC (OR 2.5, 95% CI 1.2-5.3), and babies requiring ventilation had a 65% lower likelihood of receiving DCC (OR 0.35, 95% CI 0.13-0.88). Despite the existen...
A study of effect of delayed and early umbilical cord clamping on neonatal haemoglobin status
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Delayed cord clamping has been supported by physician because it allows for physiological transfer of blood from placenta to the infant and thus permits placenta to newborn transfusion and results in an increased neonatal blood volume at birth. At present there is no standard definition of delayed cord clamping. Clamping time varies significantly between studies and a wide range of parameters were used for clamping of cord.Methods: This was an observational study conducted in a public hospital among 200 uncomplicated full-term pregnancies where 100 each were present in early cord clamping (ECC) and delayed cord clamping (DCC) groups respectively and neonatal haematological parameters studied according to different cord clamping times.Results: There was a significant increase of mean haemoglobin level from 14.8 to 16.0 g/dl from 15 secs to 60 secs and gradual increase of mean haemoglobin level from 16.2 to 16.8 g/dl from 60 secs to 180 secs. There was a highly significant...
Placental Cord Drainage Versus Clamping for Prevention of Blood Loss in the Third Stage of Labour
The Medical Journal of Cairo University, 2020
Background: Third stage of labour may contribute greatly in postpartum haemorrhage and maternal mortality if not well conducted. Unclamping of the maternal side of the umbilical cord after cutting may allow the placental cord blood to release freely and minimize blood loss. Aim of Study: This study aimed to investigate the effect of placental cord drainage on outcome of the third stage of labour.
Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes
Background: Recent protocol proposed by the World Health Organization to manage the third stage of labour replaced the early cord clamping by deferred cord clamping to induce numerous neonatal benefits. But this practice is still resisted in most of the Arab countries. The aim of this study was to evaluate the effectiveness of deferred versus early umbilical cord clamping on maternal and neonatal outcomes. Methods: A quasi experimental research design was utilized. The study was conducted at labour unit in Damanhour National Medical Institute. Sample: A convenience sample of 150 parturient women undergoing normal vaginal delivery were randomly divided in two groups; deferred cord clamping (n= 75) and early cord clamping (n= 75). Tools: Three tools were used for data collection; 1) Structured interview schedule to collect data about the women' demographic characteristics and reproductive history. 2) Maternal outcomes assessment sheet. 3) Neonatal outcomes assessment sheet to assess the immediate and late neonatal outcomes. Results: There were no statistically significant differences (P > 0.05) between deferred and early cord clamping groups in relation to the maternal risk for post-partum hemorrhage, duration of third stage of labour and the need for manual removal of the placenta. Furthermore, a highly statistically significant differences (p < 0.001) were observed regarding neonatal hemoglobin, hematocrit, and red blood cells between the two groups. The mean total bilirubin level was significantly higher (P < 0.05) in the deferred cord clamping group than early cord clamping group. Conclusion: The study concluded that deferred umbilical cord clamping did not increase the risk of maternal post-partum hemorrhage, duration of third stage of labour or the need for manual removal of the placenta. Also, deferred cord clamping significantly increased neonatal hemoglobin, hematocrit, and red blood cells level without serious elevation in the total bilirubin level as it was still in the low intermediate risk or below 75 th percentile. Recommendation: Institutionalization of deferred cord clamping in all governmental hospitals and medical educational settings through providing policies, procedures and guidelines regarding this practice. This could significantly improve the intra-natal care for the neonate without harmful consequences for the mother. Cite This Article: Wafaa Taha Ibrahim Elgzar, Heba Abdel-Fatah Ibrahim, and Hanan Heiba Elkhateeb, " Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2016
To compare the time in the third stage of labour, differences in maternal hematologic parameters 48 h after birth and acid-base status in the umbilical cord between the early cord clamping (ECC) and delayed cord clamping (DCC). Study design: 97 healthy pregnancies at term and a spontaneous vertex delivery at Clinic University Hospital "Virgen de la Arrixaca" (Murcia, Spain), were randomized to ECC group (<10 s post-delivery) or to DCC group (2 min post-delivery). Duration of the third stage of labour was measured. Samples for acidbase status were taken both from the umbilical artery and vein. Blood samples were taken from the mothers 48 h after birth. Results: No statistical differences were found in the time of the third stage of labour (p = 0.35). No statiscally significant differences were found between the number of red cells (p = 0.25), hemoglobin (p = 0.08) or hematocrit (p = 0.15) in mothers. Umbilical acid-base status or gas analysis did not show any differences between the two groups Conclusions: Delayed cord clamping does not affect significantly the time of the third stage of labour. It does not show either any effect on the hematological parameters in the mother 48 h after birth. 2016 Elsevier Ireland Ltd. All rights reserved.
Early versus delayed cord clamping of term births in Shatby Maternity University Hospital
Abstract Back ground: The optimal timing for cord clamping; early versus delayed in the third stage of labour, is a controversial subject . There are no formed practice guidelines. Objective: To compare the potential benefits and harms of early versus late clamping in term infants in Shatby Maternity Hospital. Methods : A randomized study was conducted on 100 primigravide full term single pregnancy admitted and delivered spontaneously at Shatby Maternity University Hospital . They were divided into two groups (each 50) where in the first group the umbilical cord was clamped immediately “early cord clamping ” (ECC) and where the 2nd group the umbilical cord was clamped after pulsation had been ceased” delayed cord clamping” (DCC) and then Apgar score, Hemoglobin level , random blood sugar, oxygen saturation and bilirubin after 72 hours of labour of newborn were compared and analyzed . Results: There was no statistical significant difference between both groups as regards Apgar score , haemoglobin , Random blood sugar and bilirubin while , there was a statistical significant difference as regard O2 saturation . Conclusion: Delayed cord clamping is likely to result in better neonatal outcome. Key words: Early cord clamping (ECC), Delayed cord clamping (DCC), umbilical cord (UC).