The Effects Of Delayed Cord Clamping On The Outcomes Of Neonates And Maternal During Perinatal Period

Umbilical cord clamping is one of the most important steps in the process of third stage of labor.Timing of umbilical cord clamping has been and still is a highly controversial issue.Until recently,clamping of the umbilical cord was done a few seconds after birth.This was based on the rationale that early interruption of foetal circulation would be beneficial to the newborn by helping prevent complications such as polycythaemia,hyperviscosity,hyperbilirubinaemia,or transient tachypnoea[1].However,in recent years,some scholars have put forward different opinions on the treatment of umbilical cord clamping.There is still blood left in the umbilical cord vessels that represents a portion of the fetal circulation.Waiting a longer period to clamp the umbilical cord has been shown to allow more blood from the placental circulation to enter the neonatal circulation;this is known as placental autotransfusion[2].Delayed cord clamping can reduce the rate of neonatal anemia and blood transfusion;reduce neonatal dyspnea,anemia and other short-term and long-term complications[3].DCC,which is a safe,simple and low-cost delivery procedure,should be incorporated in the routine labour management.It could serve as an additional cost-effective intervention within integrated programmes aimed at reducing IDA in infants in developing countries[4].At present,there is a tendency to recommend increasingly delayed clamping of the cord,on average 2---3 min after birth,and in some cases until the cord has ceased pulsating,after delivery[5].This shift is due to the multiple benefits that this practise can afford: higher haemoglobin and haematocrit levels,increased iron stores,and earlier and longer mother--child contact[6-8].Under normal conditions,the blood volume of the foetus is around 70 ml/kg and the placenta contains about 45 ml/kg of foetal blood.When clamping of the cord is delayed,approximately 20-35 ml/kg of blood can be transfused to the newborn,increasing the foetal blood volume by up to 50 %[9].At present,the delayed cord clamping has been recognized by a number of countries.However,there is still controversy about the best time to cut off the umbilical cord,different organizations and institutions have different guideline.To determine the best time of umbilical cord clamping,we compare the effects of delayed cord clamping on maternal postpartum hemorrhage,neonatal Apgar score,hemoglobin,hematocrit,the rate of neonatal anemia and jaundice,and so on.In view of the above considerations,we performed a clinical trial to determine the benefits and risks of delayed cord clamping to provided clinical evidence for the cord clamping during vaginal delivery.ObjectiveThis study aimed to compare the impacts of cord clamping with different time points on the maternal postpartum hemorrhage and the incidence of anemia and jaundice for vaginal birth infants during the first week,and provided clinical evidence for the cord clamping during vaginal delivery.MethodsAccording to the including criteria,the present study enrolled 663 puerperas with single fetus and natural delivery in our single center from February 2016 to December 2016.The random number table was generated through SPSS software,based on which the participants were randomized to 5 groups: A group consisted of 138 participants with immediate cord clamping;B group consisted of 128 participants with cord clamping delayed to 30s;C group consisted of 133 participants with cord clamping delayed to 1min;D group consisted of 117 participants with cord clamping after umbilical artery stopped beating;E group consisted of 147 participants with cord clamping after placental expulsion.The hemoglobin(HB),hematocrit(HCT)and the incidence of anemia in cord blood and 1-2 days and 6-8 days peripheral blood after birth were separately recorded.Meanwhile,the transcutaneous bilirubin(TCB)of infants was evaluated by transcutaneous bilirubin measurement in 1-2 and 6-8 days after birth.In addition,the postpartum hemorrhage was compared among the puerperas in the different groups mentioned above.Results1.Delayed cord clamping(DCC)improved the HB and HCT for infants,especially for the use of cord clamping after umbilical artery stopped beating and cord clamping after placenta delivery(P<0.05);2.Cord clamping after umbilical artery stopped beating with the significantly lowest incidence of anemia(P<0.05);3.Compared with immediate cord clamping(ICC),DCC did not improve the incidence of jaundice for newborn(P>0.05);4.Delayed cord clampingdid no effects on neonatal Apgar score(P>0.05);5.Compared with ICC,DCC significantly decreased the volume of postpartum hemorrhage(P=0.017).ConclusionDCC decreased the incidence of anemia without increasing the incidence of jaundice for newborn and decreased the volume of postpartum hemorrhage for puerperas;it did no effects on neonatal Apgar score.The time of umbilical artery stopped beating might be the optimal point for cord clamping.