Abstract
Objective To evaluate the implementation of an institutional protocol for universal delayed
umbilical cord clamping (DCC) at term on maternal, neonatal, and umbilical cord blood
gas outcomes.
Study Design This is a retrospective cohort study of singleton term gestations from April through
July 2017. On June 1, 2017, a protocol was implemented for DCC in all deliveries.
Outcomes were compared between patients delivered prior to and those delivered after
implementation. The primary outcome was postpartum hemorrhage (PPH). Secondary outcomes
were additional adverse maternal, neonatal, and umbilical cord blood gas outcomes.
Multivariable logistic regression was used to adjust for potential confounders.
Results Of 682 patients, 341 were delivered preprotocol and 341 were delivered postprotocol.
After implementation, there was 91.8% adherence to the protocol. Overall, there was
no significant difference in PPH between patients delivered preprotocol and those
delivered postprotocol (8.2 vs. 13.2%; adjusted relative risk [aRR]: 1.26, 95% confidence
interval [CI]: 0.98–1.51). There was a significant decrease in the ability to obtain
paired arterial and venous umbilical cord blood gases from preprotocol to postprotocol
(83 vs. 63.6%; aRR: 0.62 [95% CI: 0.50–0.76]). There were no significant differences
in abnormal umbilical cord blood gases or neonatal outcomes.
Conclusion We did not find an increased risk of adverse outcomes associated with the widespread
use of DCC.
Keywords
delayed cord clamping - delayed umbilical cord clamping - placental transfusion -
postpartum hemorrhage - umbilical cord blood gas
