A clinical audit on uptake of delayed cord clamping at caesarean sections

Abstract

Objective: To find out the level of adherence to delayed cord clamping (DCC) following delivery of neonates that do not require resuscitation by category 3 and 4 caesarean surgeries at tertiary care hospitals in Sri Lanka and the reasons for nonadherence Methodology: Out of the tertiary care hospitals in Sri Lanka, eleven were randomly selected to the study. Middle grade medical officers from each obstetric unit of each of these hospitals, who perform uncomplicated caesarean surgeries in their units, were randomly selected and invited to participate in the study. Postgraduate trainees and doctors with an experience of less than a year were excluded. Telephone based interviews were used to administer the study instrument. Results: Out of the participants (n=50), only 34% of doctors (n=17) were using DCC, while 52% of doctors (n=26) practiced early cord clamping (ECC) and 14% (n=7) practiced umbilical cord milking. Out of the doctors who practiced DCC, five doctors (29.41%) waited until cord pulsations were absent. Nine of them (52.94%) waited for one minute and three of them (17.64%) waited for only 30 seconds. Out of the participants, 74% (n=37) doctors were aware about guideline recommendations on delayed cord clamping. Out of 36 doctors who did not practice delayed cord clamping or who practiced it for less than the minimum recommended duration, 69.44% (n=25) were aware about the guideline recommendations. Among the doctors who did not practice DCC, 93.93% (n=31) mentioned that they believe DCC is associated with increased blood loss at the caesarean section and increased surgical time. Conclusions: In contrast to wide consensus on safety and positive effects of DCC, its uptake is low at ground level when it comes to caesarean section deliveries. Most of the surgeons believe that with DCC, they experience increased blood loss and increased surgical time. Either DCC should be further promoted with stronger scientific evidence for its safety at caesarean sections or alternative surgical techniques should be explored to ensure that newborns do not miss benefits of placental autotransfusion.