Effects of delayed cord clamping on neonatal jaundice, phototherapy and early hematological status in term cesarean section

Abstract Background Delayed cord clamping in full-term neonates is widely recommended, while in practice, it is rarely implemented in cesarean section due to the fear of neonatal jaundice and excessive maternal blood loss. The optimal timing of cord clamping remains uncertain. This study was to fully evaluate the effects of delayed cord clamping on short-term hematological status and jaundice in term neonates delivered by cesarean section. Methods This retrospective study enrolled 796 women, who were allocated into the early cord clamping group (n = 377) and the delayed cord clamping group (n = 419). The latter group was further divided into two subgroups (30–60 s, 61–120 s). The outcomes were neonatal transcutaneous bilirubin levels on 0 to 5 days of life and the rate of phototherapy. For neonates who had blood tests on the first three days of life, their hemoglobin and hematocrit were compared among groups. Results Compared with the early cord clamping group, delayed cord clamping merely increased the transcutaneous bilirubin level of neonates on the day of birth rather than that on the following five days. The heel peripheral blood sample size of 1–3 days in the early cord clamping group was 61, 25 and 33, and in the delayed cord clamping group was 53, 46 and 32, respectively. Delayed cord clamping at 30–60 s resulted in the higher neonatal hemoglobin level on day 3 and an increased rate of neonatal polycythemia, without a higher rate of phototherapy. Delayed cord clamping beyond 60 s did not further improve hematological status in term neonates born by cesarean section. Conclusion In cesarean section, delayed cord clamping for 30–60 s improved the early hematological status of term neonates without the enhanced requirement of phototherapy for neonatal jaundice.

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In the third stage of labor, is delayed cord clamping beneficial compared with early cord clamping for term neonates?

Evidence-Based Practice ◽

10.1097/01.ebp.0000541151.34518.00 ◽

2016 ◽

Vol 19 (2) ◽

pp. 6

Author(s):

Michael Chase Ledbetter ◽

Mitchell Duininck

Keyword(s):

Delayed Cord Clamping ◽

Term Neonates ◽

The Third ◽

Cord Clamping ◽

Third Stage Of Labor ◽

Third Stage ◽

Early Cord Clamping

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Effect of early and delayed cord clamping on hemoglobin and hematocrit among full term neonates.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.08.5574 ◽

2021 ◽

Vol 28 (08) ◽

pp. 1114-1119

Author(s):

Saqib Aslam ◽

◽

Sadaf Minhas ◽

Muhammad Azhar Farooq ◽

Beenish Bashir Mughal ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Full Term ◽

P Value ◽

Delayed Cord Clamping ◽

Term Neonates ◽

Cord Clamping ◽

Significant Difference ◽

Early Cord Clamping ◽

The Mean

Objective: To compare the mean hemoglobin levels and frequency of polycythemia in full term neonates after early and delayed cord clamping. Study Design: Randomized Controlled Trial. Setting: KRL General Hospital Islamabad (Labor Room/ Neonatology). Periods: December 2017 to June 2018. Material & Methods: 190 full term neonates were selected and divided into 2 equal groups randomly: Early cord clamping group after delivery and late cord clamping group. Two hours after clamping the venous blood samples were taken for the hemoglobin and hematocrit levels. Mean and standard deviation were calculated for gestational age, birth weight, hemoglobin and hematocrit. Frequency and proportions were calculated for gender and polycythemia. Results: Mean gestational age of the mothers was 39.27 ± 1.50 weeks. Of 190 neonates, 91 (47.9%) were males, 99 (52.1%) were females. Mean birth weight was 3.64 ± 0.72 kg while mean Hb and HCT levels were 16.07 ± 2.30 g/dl and 63.26 ± 5.32% respectively. Keeping cut off value of 13.5 g/dl of Hb to label anemia or no, 35 (18.4%) neonates were anemic in this study. The polycythemia (HCT >65%) was present in 72 (37.9%) of neonates. There was no difference between groups in terms of gender, anemia, gestational age and birth weight (p values 0.663, 0.852, 0.700 and 0.491 respectively). The distribution of polycythemia was different among groups (p value 0.007). The mean hemoglobin level in group A was 15.52 ± 1.90 g/dl while in group B it was 16.62 ± 2.53 g/dl (p value 0.001). Mean Hb levels were statistically not different among some of the groups (gestational age <40 weeks, birth weight <4 kg) while HCT levels are significantly different among male group and category of birth weight >4 kg. Rest of the stratification groups showed significant difference. Conclusion: The delayed cord clamping in neonates results in increased mean hemoglobin and hematocrit levels with increased frequency of polycythemia as compared to early cord clamping.

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FEASIBILITY AND OUTCOME OF DELAYED CORD CLAMPING IN TERM CESAREAN SECTION BORN NEONATES

10.36106/4812033 ◽

2021 ◽

pp. 4-5

Author(s):

Bhaswati Ghoshal ◽

Argha Maitrya ◽

Tanmay Majumdar ◽

Ivy Mandal

Keyword(s):

Cesarean Section ◽

Serum Ferritin ◽

Postpartum Haemorrhage ◽

Tertiary Care ◽

Iron Store ◽

Care Hospital ◽

Cesarean Sections ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Early Cord Clamping

Background: Through delayed cord clamping is recommended, it is less frequently performed in cases of cesarean sections .In this study delayed cord clamping was requested to obstetricians in term well newborn who cried at birth and followed these neonates during hospital stay and till 6 weeks of life and also compared with cases in whom early cord clamping was done. Objective:To nd out the feasibility of delayed cord clamping in term newborns delivered by cesarean section and its outcomes in rst few days of life in terms of jaundice , NICU stay and hemoglobin and serum ferritin at 6weeks of age. Setting :Tertiary care hospital (Calcutta national medical college) in department of Obstetrics from March to December,2019. Design-Prospective observational cohort study Method- During this period total 3732 cesarean sections was done on term pregnancy. Obstreticians were requested for delayed cord clamping for more than 120 seconds where baby cried at birth by a counseling session of 30 minutes. Outcome was compared with early cord clamping cases(10-15secs) at early neonatal period for jaundice ,NICU stay and at 6weeks for hemoglobin and serum ferritin. RESULTS: In 236 cases (6.37% ) it was feasible to perform delayed cord clamping after requesting obstetricians. There is no signicant difference in jaundice, morbidity, maternal postpartum haemorrhage in delayed cord clamping group in early neonatal period.Haemoglobine [11.9+- 0.5gm/dl vs 9.5 +-0.5gm/dl(p<0.01)]and ferritin[339+-102ng/ml vs 179+-99ng/ml(p<0.01)] levels were signicantly more in delayed cord clamping group at 6weeks of postnatal age. Conclusion: Feasibility of delayed cord clamping is still very low in cesarean delivery but strongly recommended for building iron store in neonates. Delayed cord clamping for 120 seconds does not increase postpartum haemorrhage in mother.

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Early versus delayed cord clamping in term neonates.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.05.4578 ◽

2021 ◽

Vol 28 (05) ◽

pp. 656-660

Author(s):

Samina Mumtaz ◽

Shagufta Tabassum ◽

Saima Afzal

Keyword(s):

Gestational Age ◽

Controlled Trial ◽

Hemoglobin Level ◽

Delayed Cord Clamping ◽

Term Neonates ◽

Cord Clamping ◽

Significant Difference ◽

Early Cord Clamping ◽

Group A ◽

Group B

Objective: To compare mean hemoglobin levels of neonates after early and late cord clamping. Study Design: Randomized Controlled Trial. Setting: Department of Obstetrics & Gynaecology at Nishtar Hospital Multan. Period: June 2019 to December 2019. Material & Methods: A total of 60 women booked and unbooked were included in study. Selected patients randomized into group A and B, each group comprising of 30 patients depending upon the envelope with assigned treatment (either early or delayed cord clamping) picked up by the patient. Results: In present study, two groups were made. Group A consisted of 30 neonates in whom early cord clamping was done while in group B delayed clamping was done in 30 neonates. Mean age of mothers was 28.4±0.4 vs. 28.6±0.5 years in group A and B respectively. There were 25 mothers (83.3%) in group A and 21 mothers (70%) in group B between 25–30 years. There were 5 mothers (16.7%) in group A and 8 mothers (26.7%) in group B between 31–35 years of age. While none of the mother in group A and 1 mother (3.3%) in group B was between 36–40 years of age. Mean parity of the mothers was 1.1±0.2 vs. 1.4±0.2 in group A and B respectively. Eight mothers (85.4%) in group A and 7 mothers (82.5%) in group B were primipara. While 22 mothers (14.6%) in group A and 23 mothers in group B (17.5%) were para 1–3. Gestational age was 37–38 weeks in 13(43.3%) vs. 19(63.3%) women in group A and B respectively. While there were 17(56.7%) vs. 11(36.7%) women in group A and B respectively of the gestational age 39–40 weeks. Pre-delivery maternal mean hemoglobin levels was 11.9±0.1 gm/dl vs. 12.3±0.1 gm/dl in group A and B respectively. Pre-delivery maternal hemoglobin levels were 10–10.9 g/dl in 2 mothers (6.7%) vs. 1 mother (3.3%) in group A and B respectively. Neonatal mean hemoglobin levels were 16.8±0.2 g/dl vs. 17.7±0.1 g/dl in group A and B respectively. Out of the 31 booked mothers, neonatal mean hemoglobin level was 16.8±0.2 g/dl vs. 17.9±0.1 g/dl in group A and B respectively. While out of the 29 unbooked mothers, neonatal mean hemoglobin level was 16.7±0.2 g/dl vs. 17.5±0.1 g/dl in group A and B respectively. When compared the neonatal mean hemoglobin levels, there was significant difference between mean hemoglobin levels of neonates between the two groups (p=0.000). Conclusion: Delayed cord clamping in term neonates for a minimum of 2 minutes at birth is beneficial to the newborn in terms of improved hemoglobin levels. There is no significant difference seen in pre-delivery maternal hemoglobin levels and neonatal hemoglobin either in delayed cord clamping group or in early cord clamping group.

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Delayed Cord Clamping in Term Neonates: Attitudes and Practices of Midwives in Irish Hospitals

International Journal of Childbirth ◽

10.1891/2156-5287.8.1.4 ◽

2018 ◽

Vol 8 (1) ◽

pp. 4-17 ◽

Cited By ~ 3

Author(s):

Joan Devin ◽

Patricia Larkin

Keyword(s):

Umbilical Cord ◽

Active Management ◽

Delayed Cord Clamping ◽

Term Neonates ◽

The Third ◽

Cord Clamping ◽

Third Stage Of Labor ◽

Maternity Hospitals ◽

Third Stage ◽

Early Cord Clamping

Background:At the time of birth, the baby is attached to its mother’s placenta via the umbilical cord. A delay in cord clamping is physiologically beneficial to the neonate as they receive an increase in blood volume (30%–40%), increased iron stores (20–30mg/kg), and an easier transition to extrauterine life. Active management of the third stage of labor, in order to prevent maternal postpartum hemorrhage, may contribute to early cord clamping practices in Ireland. Objective:To describe the current practices and attitudes of midwives in Irish hospitals toward delayed cord clamping in term neonates. Methods:A cross-sectional descriptive survey was distributed to three maternity hospitals and two Irish online midwifery groups. Results:One hundred and fifty-three valid responses were received. One hundred and eleven midwives (72.4%) defined delayed cord clamping as “clamping after the cord ceases to pulsate.” One hundred and forty (91.5%) respondents practiced delayed cord clamping. Moreover, 62.7 % (98/153) of participants routinely clamp the umbilical cord >1 minute when practicing active management of the third stage, with 49.1% (48/98) of those waiting until cord pulsations have ceased. Awareness of research, practice guidelines advising delayed cord clamping, and experience of practicing physiological third stage are associated with increased delayed cord clamping practices. Early cord clamping is influenced by a deteriorating neonatal or maternal condition and the cultural context within clinical sites. Delayed cord clamping times during active management of the third stage differ significantly between clinical sites and maternity care pathways.Conclusion:A variety of midwifery practices were identified with differing attitudes toward cord clamping practices. Diverse influences included the practice environment, awareness of research, and availability of adjunct resuscitation supports. Recommendations for future practice include a synchronized approach to delayed cord clamping in the third stage of labor, including the provision of a national guideline.

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Implementation of Delayed Cord Clamping for 3 Min During Term Cesarean Sections Does Not Influence Maternal Blood Loss

Frontiers in Pediatrics ◽

10.3389/fped.2021.662538 ◽

2021 ◽

Vol 9 ◽

Author(s):

Stefanie Celen ◽

Emily J. J. Horn-Oudshoorn ◽

Ronny Knol ◽

Eline C. van der Wilk ◽

Irwin K. M. Reiss ◽

...

Keyword(s):

Blood Loss ◽

Cesarean Section ◽

Postpartum Hemorrhage ◽

Maternal Blood ◽

Bleeding Complications ◽

Cesarean Sections ◽

Delayed Cord Clamping ◽

Tertiary Referral Hospital ◽

Cord Clamping ◽

Local Protocol

Background: To assess maternal safety outcomes after a local protocol adjustment to change the interval of cord clamping to 3 min after term cesarean section.Design, Setting, and Patients: A retrospective cohort study in a tertiary referral hospital (Erasmus MC, Rotterdam). We included pregnant women who gave birth at term after cesarean section. A cohort (Nov 2016–Oct 2017) prior to the protocol implementation was compared to a cohort after its implementation (Nov 2017–Nov 2018). The study population covered 789 women (n = 376 pre-cohort; n = 413 post-cohort).Interventions: Implementation of a local protocol changing the interval of cord clamping to 3 min in all term births.Main outcome measures: Primary outcomes were the estimated maternal blood loss and the occurrence of postpartum hemorrhage (blood loss >1,000 ml). Secondary outcomes included both maternal as well as neonatal outcomes.Results: Estimated maternal blood loss was not significantly different between the pre-cohort and post-cohort (400 mL [300–600] vs. 400 mL [300–600], p = 0.52). The incidence of postpartum hemorrhage (26 [6.9%] vs. 35 (8.5%), OR 1.24, 95% CI 0.73–2.11) and maternal blood transfusion (9 [2%] vs. 13 (3%), OR 1.33, 95% CI 0.56–3.14) were not different. Hemoglobin change was significantly higher in the post-cohort (−0.8 mmol/L [−1.3 to −0.5] vs. −0.9 mmol/L [−1.4 to −0.6], p = 0.01). In the post-cohort, neonatal hematocrit levels were higher (51 vs. 55%, p = 0.004) and need for phototherapy was increased (OR 1.95, 95% CI 0.99–3.84).Conclusion: Implementation of delayed cord clamping for 3 min in term cesarean sections was not associated with increased maternal bleeding complications.

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Delayed Cord Clamping versus Early Cord Clamping in Elective Cesarean Section: A Randomized Controlled Trial

Neonatology ◽

10.1159/000500325 ◽

2019 ◽

Vol 116 (3) ◽

pp. 252-259 ◽

Cited By ~ 4

Author(s):

Francesco Cavallin ◽

Beatrice Galeazzo ◽

Vittoria Loretelli ◽

Stefania Madella ◽

Martina Pizzolato ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cesarean Section ◽

Controlled Trial ◽

Elective Cesarean Section ◽

Delayed Cord Clamping ◽

Randomized Controlled ◽

Cord Clamping ◽

Early Cord Clamping ◽

Elective Cesarean

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Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord

Children ◽

10.3390/children8050353 ◽

2021 ◽

Vol 8 (5) ◽

pp. 353

Author(s):

Jayasree Nair ◽

Lauren Davidson ◽

Sylvia Gugino ◽

Carmon Koenigsknecht ◽

Justin Helman ◽

...

Keyword(s):

Blood Flow ◽

Perinatal Asphyxia ◽

Arterial Blood Flow ◽

Positive Pressure ◽

Optimal Timing ◽

Delayed Cord Clamping ◽

Arterial Blood ◽

Cord Clamping ◽

Sustained Inflation ◽

Near Term

The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted.

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