Implementation and Outcomes of Universal Delayed Umbilical Cord Clamping at Term

2018 ◽  
Vol 36 (03) ◽  
pp. 233-242 ◽  
Author(s):  
Victoria Wesevich ◽  
Methodius Tuuli ◽  
George Macones ◽  
Alison Cahill ◽  
Janine Rhoades
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Blood Gases ◽  
Adjusted Relative Risk ◽  
Blood Gas ◽  
Cord Clamping ◽  
Increased Risk ◽  
Significant Difference ◽  
Umbilical Cord Clamping

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.

scholarly journals Delayed Umbilical Cord Clamping at <32 Weeks' Gestation: Implementation and Outcomes

2017 ◽  
Vol 34 (11) ◽  
pp. 1048-1053
Author(s):  
Tatiana Bierut ◽  
Shayna Conner ◽  
Methodius Tuuli ◽  
Zachary Vesoulis ◽  
George Macones ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Blood Gases ◽  
Maternal Outcomes ◽  
Blood Gas ◽  
Cord Clamping ◽  
Significant Difference ◽  
Umbilical Cord Clamping ◽  
The Impact

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.

Delayed cord clamping does not affect umbilical cord blood gas analysis

2019 ◽  
Vol 299 (3) ◽  
pp. 719-724 ◽  
Author(s):  
Jiachen Tang ◽  
Rachel Fullarton ◽  
Sheri-Lee Samson ◽  
Yu Chen
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Delayed Cord Clamping ◽  
Cord Clamping

scholarly journals Cellular Subsets of Maternal Microchimerism in Umbilical Cord Blood

2018 ◽  
Vol 28 (5) ◽  
pp. 522-528
Author(s):  
Anna Maria Jonsson Kanold ◽  
Magnus Westgren ◽  
Cecilia Götherström
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cesarean Sections ◽  
Hematopoietic Progenitor ◽  
Cord Clamping ◽  
Vaginal Deliveries ◽  
Umbilical Cord Clamping ◽  
Elective Cesarean ◽  
Total Dna

Maternal microchimerism may arise in the offspring during pregnancy, and may be favorable or unfavorable. Additionally, maternal cells present in umbilical cord blood used for stem cell transplantation may affect the outcome after transplantation. The aim of this study was to evaluate the cellular subset and frequency of maternal cells in umbilical cord blood following vaginal deliveries and elective Cesarean sections where the umbilical cord clamping time was measured. A total of 44 healthy women with normal pregnancies were included in the study. Of these, 24 delivered vaginally and 20 by elective Cesarean sections. In the fresh umbilical cord blood, cellular subsets of CD3+ (T-cells), CD19+ (B-cells), CD33+ (myeloid cells), CD34+ (hematopoietic progenitor cells) and CD56+ (natural killer cells) cells were isolated and DNA extracted. A single-nucleotide polymorphism unique to the mother was identified and maternal microchimerism in the different cellular fractions was detected using quantitative real-time polymerase chain reaction with a sensitivity of 0.01%. Overall, 5 out of the 44 (11%) umbilical cord blood samples contained maternal microchimerism. The positive fractions were total DNA (whole blood, n = 3), CD34+ ( n = 1), CD56+ ( n = 1) and CD34+/CD56+ ( n = 1). Overall, four of the five (80%) positive samples were from Cesarean sections and one was from a vaginal delivery. The conclusion from this study is that maternal microchimerism in umbilical cord blood is not a common phenomenon but includes both lymphoid and hematopoietic progenitor lineages.

scholarly journals CD34+ stem cells from umbilical cord blood

2011 ◽  
Vol 1 (3) ◽  
pp. 79 ◽  
Author(s):  
Carlo Pafumi ◽  
Vito Leanza ◽  
Antonio Carbonaro ◽  
Gianluca Leanza ◽  
Alessandra Iemmola ◽  
...  
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Survival Rates ◽  
Blood Collection ◽  
Colony Forming Unit ◽  
Cord Clamping ◽  
Umbilical Cord Clamping

We describe the relation between umbilical cord clamping time and two different enrichment system of CD34+ stem cells from umbilical cord blood with the proliferative ability and bone marrow reconstitution of the stem cells obtained. After an obstetrician performed the cord blood collection, the purification of stem cells was performed either with a combination of monoclonal antibodies (negative selections) using the Stem Sep method, or with a positive cells selection based on their surface CD34 antigens using the Mini Macs system. An excellent recovery of haematopoietic progenitors [Burst Forming Unit Erythroids (BFUE); Colony Forming Unit Granulocytes and Macrophages (CFU-GM); and Colony Forming Unit Granulocytes, Erythroids, Monocytes and Macrophages (CFU-GME)], inversely related to the increase in clamping time, was performed with the Mini Macs system (54% of colonies, with 90% purity). With Stem Sep method, haematopoietic progenitor’s recovery was 35% (with 80% purity). By applying early clamping of umbilical cord blood we obtained a greater number of CD34+ cells and their clonogenic activity was increased with enrichment. This is a useful technique considering that the number of CD34+ stem cells usually contained from a unit of placental blood is enough for the transplant to a child, but not for an adult. Thus, using these methods, we can get a larger number of CD34+ stem cells which reduces the risk of Graft versus Host Disease also in adult patients, producing survival rates similar to those obtained with transplantation of bone marrow from unrelated donors.

Obstetrical and neonatal factors associated with optimal public banking of umbilical cord blood in the context of delayed cord clamping

2019 ◽  
Vol 42 (3) ◽  
pp. E56-E63 ◽  
Author(s):  
Anna Munro ◽  
Daniel J. Corsi ◽  
Lisa Martin ◽  
Michael Halpenny ◽  
Nicholas Dibdin ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Delayed Cord Clamping ◽  
Factors Associated ◽  
Cell Counts ◽  
Cord Clamping ◽  
Newborn Weight ◽  
Cord Blood Banks

Purpose: To assess the association of specific newborn and maternal factors with indicators of increased blood-forming capacity in umbilical cord blood to inform strategic collection strategies that could augment the quality of units in public cord blood banks. Methods: Data regarding 268 consecutive cord blood units (CBUs) banked by Canadian Blood Services were analyzed. Multivariate analysis was performed to identify factors associated with markers of hematopoietic potency and likelihood of utilization. Results: Delayed clamping of the cord beyond 60 s was associated with reduced volume collected. Any delay in clamping of the cord was associated with reduced total nucleated cell counts. Newborn weight >4,000 g was also associated with greater blood volume in the collection but not with other measures of hematopoietic potency. Cord blood acidosis at birth (pH

Standardized Evaluation of Cord Gases in Neonates at Risk for Hypoxic Ischemic Encephalopathy

2021 ◽  
Author(s):  
Elizabeth Blecharczyk ◽  
Lucy Lee ◽  
Krista Birnie ◽  
Arun Gupta ◽  
Alexis Davis ◽  
...  
Keyword(s):  
At Risk ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Care Pathway ◽  
Clinical Care ◽  
Blood Gases ◽  
Hypoxic Ischemic Encephalopathy ◽  
Blood Gas ◽  
Clinical Care Pathway ◽  
Ischemic Encephalopathy

BACKGROUND: Umbilical-cord acidemia may indicate perinatal asphyxia and places a neonate at increased risk for hypoxic ischemic encephalopathy (HIE). Our specific aim was to develop a standardized clinical care pathway, ensuring timely identification and evaluation of neonates with umbilical-cord acidemia at risk for HIE. METHODS: A standardized clinical care pathway to screen inborn neonates ≥36 weeks with abnormal cord blood gases (a pH of ≤7.0 or base deficit of ≥10) for HIE was implemented in January 2016. Abnormal cord blood gases resulted in a direct notification from the laboratory to an on-call physician. Evaluation included a modified Sarnat examination, postnatal blood gas, and standardized documentation. The percentage of neonates in which physician notification, documented Sarnat examination, and postnatal blood gas occurred was examined for 6 months before and 35 months after implementation. RESULTS: Of 203 neonates with abnormal cord gases in the post–quality improvement (QI) period, physician notification occurred in 92%. In the post-QI period, 94% had a documented Sarnat examination, and 94% had postnatal blood gas, compared with 16% and 11%, respectively, of 87 neonates in the pre-QI period. In the post-QI period, of those evaluated, &gt;96% were documented within 4 hours of birth. In the post-QI period, 15 (7.4%) neonates were cooled; 13 were in the NICU at time of identification, but 2 were identified in the newborn nursery and redirected to the NICU for cooling. CONCLUSIONS: A standardized screening pathway in neonates with umbilical-cord acidemia led to timely identification and evaluation of neonates at risk for HIE.

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