Delayed Umbilical Cord Clamping at <32 Weeks' Gestation: Implementation and Outcomes
27 April 2017
28 April 2017
25 May 2017 (eFirst)
Objectives This study aims to evaluate the implementation of a delayed umbilical cord clamping (DCC) protocol for neonates <32 weeks. Secondarily, to evaluate the impact of DCC on maternal outcomes and on the ability to obtain umbilical cord blood gases.
Study Design Retrospective cohort study from November 2014 to March 2016 of patients delivered by 316/7 weeks. In 2014, an institutional protocol for DCC at <32 weeks was implemented. We assessed adherence to the protocol and compared adverse maternal outcomes (utilizing a hemorrhage composite). We evaluated the impact of DCC on the ability to obtain adequate umbilical cord blood gas specimens.
Results Of the 185 patients included in the study, 90 underwent DCC, and 72% of potentially eligible patients appropriately received DCC. There was no significant difference in the maternal hemorrhage composite outcome between DCC and immediate cord clamping (23.3 vs. 36.8%, adjusted odds ratio = 0.64, 95% confidence interval = 0.33, 1.26). There was also no significant difference in the ability to obtain a single or paired umbilical cord blood gas result.
Conclusion Implementation of a DCC protocol for preterm neonates is feasible and was successful. We did not find an increase in maternal risk or a decrease in the ability to obtain umbilical cord blood gases following DCC.
Keywordsdelayed cord clamping - delayed umbilical cord clamping - timing of cord clamping - umbilical cord blood gas - umbilical cord clamping
Poster presented at the 37th Annual Meeting of the Society for Maternal–Fetal Medicine; January 23–28, 2017; Las Vegas, NV.
- 1 Aladangady N, McHugh S, Aitchison TC, Wardrop CA, Holland BM. Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006; 117 (01) 93-98
- 2 Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; (08) CD003248 . Doi: 10.1002/14651858.CD003248.pub3
- 3 Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006; 117 (04) 1235-1242
- 4 Kinmond S, Aitchison TC, Holland BM, Jones JG, Turner TL, Wardrop CA. Umbilical cord clamping and preterm infants: a randomised trial. BMJ 1993; 306 (6871): 172-175
- 5 Rabe H, Wacker A, Hülskamp G. , et al. A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr 2000; 159 (10) 775-777
- 6 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee Opinion No.543: Timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120 (06) 1522-1526
- 7 Westgate J, Garibaldi JM, Greene KR. Umbilical cord blood gas analysis at delivery: a time for quality data. Br J Obstet Gynaecol 1994; 101 (12) 1054-1063
- 8 Bolstridge J, Bell T, Dean B. , et al. A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants. BMC Pediatr 2016; 16 (01) 155 . Doi: 10.1186/s12887-016-0692-9
- 9 Aziz K, Chinnery H, Lacaze-Masmonteil T. A single-center experience of implementing delayed cord clamping in babies born at less than 33 weeks' gestational age. Adv Neonatal Care 2012; 12 (06) 371-376
- 10 Kuo K, Gokhale P, Hackney DN, Ruangkit C, Bhola M, March M. Maternal outcomes following the initiation of an institutional delayed cord clamping protocol: an observational case-control study. J Matern Fetal Neonatal Med 2017; 1-5
- 11 McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; (07) CD004074 . Doi: 10.1002/14651858.CD004074.pub3
- 12 Tuuli MG, Stout MJ, Macones GA, Cahill AG. Umbilical Cord Venous Lactate for Predicting Arterial Lactic Acidemia and Neonatal Morbidity at Term. Obstet Gynecol 2016; 127 (04) 674-680
- 13 Andersson O, Hellström-Westas L, Andersson D, Clausen J, Domellöf M. Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial. Acta Obstet Gynecol Scand 2013; 92 (05) 567-574
- 14 De Paco C, Florido J, Garrido MC, Prados S, Navarrete L. Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Arch Gynecol Obstet 2011; 283 (05) 1011-1014
- 15 Valero J, Desantes D, Perales-Puchalt A, Rubio J, Diago Almela VJ, Perales A. Effect of delayed umbilical cord clamping on blood gas analysis. Eur J Obstet Gynecol Reprod Biol 2012; 162 (01) 21-23
- 16 Wiberg N, Källén K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG 2008; 115 (06) 697-703
- 17 Committee on Obstetric Practice. Committee Opinion No. 684: Delayed Umbilical Cord Clamping After Birth. Obstet Gynecol 2017; 129 (01) e5-e10