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Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
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2013 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 5, 567-574 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To investigate the effect of delayed cord clamping (DCC) compared with early cord clamping (ECC) on maternal postpartum hemorrhage (PPH) and umbilical cord blood gas sampling.

Design

Secondary analysis of a parallel-group, single-center, randomized controlled trial.

Setting

Swedish county hospital.

Population

382 term deliveries after a low-risk pregnancy.

Methods

Deliveries were randomized to DCC (≥180 seconds, n = 193) or ECC (≤10 seconds, n = 189). Maternal blood loss was estimated by the midwife. Samples for blood gas analysis were taken from one umbilical artery and the umbilical vein, from the pulsating unclamped cord in the DCC group and from the double-clamped cord in the ECC group. Samples were classified as valid when the arterial-venous difference was -0.02 or less for pH and 0.5 kPa or more for pCO2.

Main outcome measures

PPH and proportion of valid blood gas samples.

Results

The differences between the DCC and ECC groups with regard to PPH (1.2%, p = 0.8) and severe PPH (-2.7%, p = 0.3) were small and non-significant. The proportion of valid blood gas samples was similar between the DCC (67%, n = 130) and ECC (74%, n = 139) groups, with 6% (95% confidence interval: -4%-16%, p = 0.2) fewer valid samples after DCC.

Conclusions

Delayed cord clamping, compared with early, did not have a significant effect on maternal postpartum hemorrhage or on the proportion of valid blood gas samples. We conclude that delayed cord clamping is a feasible method from an obstetric perspective.

Place, publisher, year, edition, pages
2013. Vol. 92, no 5, 567-574 p.
National Category
Medical and Health Sciences
Research subject
Medical Science; Obstetrics and Gynaecology; Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-196866DOI: 10.1111/j.1600-0412.2012.01530.xISI: 000319060200011PubMedID: 22913332OAI: oai:DiVA.org:uu-196866DiVA: diva2:611018
Available from: 2013-03-14 Created: 2013-03-14 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Effects of Delayed versus Early Cord Clamping on Healthy Term Infants
Open this publication in new window or tab >>Effects of Delayed versus Early Cord Clamping on Healthy Term Infants
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to study maternal and infant effects of delayed cord clamping (≥180 seconds, DCC) compared to early (≤10 seconds, ECC) in a randomised controlled trial. Practice and guidelines regarding when to clamp the cord vary globally, and different meta-analyses have shown contradictory conclusions on benefits and disadvantages of DCC and ECC.

The study population consisted of 382 term infants born after normal pregnancies and randomised to DCC or ECC after birth. The primary objective was iron stores and iron deficiency at 4 months of age, but the thesis was designed to investigate a wide range of suggested effects associated with cord clamping.

Paper I showed that DCC was associated with improved iron stores at 4 months (45% higher ferritin) and that the incidence of iron deficiency was reduced from 5.7% to 0.6%. Neonatal anaemia at 2-3 days was less frequent in the DCC group, 1.2% vs. 6.3%. There were no differences between the groups in respiratory symptoms, polycythaemia, or hyperbilirubinaemia.

In paper II we demonstrated that DCC versus ECC was not associated with higher risk for maternal post partum haemorrhage and rendered a comparable ratio of valid umbilical artery blood gas samples.

In paper III, the Ages and Stages Questionnaire was used to assess neurodevelopment at 4 months. The total scores did not differ, but the DCC group had a higher score in the problem-solving domain and a lower score in the personal-social domain. Immunoglobulin G level was 0.7 g/L higher in the DCC group at 2–3 days, but did not differ at 4 months. Symptoms of infection up to 4 months were comparable between groups.

Finally, in paper IV, iron stores and neurodevelopment were similar between groups at 12 months. Gender specific outcome on neurodevelopment at 12 months was discovered, implying positive effects from DCC on boys and negative on girls.

We conclude that delaying umbilical cord clamping for 180 seconds is safe and associated with a significantly reduced risk for iron deficiency at 4 months, which may have neurodevelopmental effects at a later age.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 893
Keyword
active management, birth, breast feeding, cord clamping, ferritin, growth, haemoglobin, human infant, infections, iron, iron deficiency, iron deficiency anemia, iron status, morbidity, neurodevelopment, randomised controlled trial, umbilical cord
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-198167 (URN)978-91-554-8647-1 (ISBN)
Public defence
2013-05-23, Rosénsalen, Ingång 95/96, Akademiska Barnsjukhuset, Uppsala, 09:30 (English)
Opponent
Supervisors
Available from: 2013-04-29 Created: 2013-04-10 Last updated: 2013-08-30Bibliographically approved

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Andersson, OlaHellström-Westas, Lena

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