Active Management of Third Stage Labor Is Associated with a Lower Cord Blood Unit Volume.

Abstract

Aim: It has been demonstrated that active management of third stage of labour (AMTSL) (prophylactic administration of a uterotonic agent, early cord blood clamping and controlled cord blood traction) reduces the risk of primary post partum haemorrhage compared with expectant (or physiological) management. However this strategy might decrease the cord blood unit (CBU) volume which is collected in order to be banked for therapeutic use. Knowing that efficacy of CBU transplantation correlates with CD34+ progenitor cells content (which is correlated with the collected volume of CBU), we conducted a retrospective study to analyse the impact of AMTSL on volume and CD34 progenitor's content of CBU.Material and Method: From Jan 1st 2001 to Oct 2nd, 2004 the maternity affiliated to the Besançon CBB performed 3838 CBU collections after normal deliveries. Different factors that might impact on CBU volume and CD34+ cell content were analysed: age, parity, and smoking habit of the mother, gestational age, type of initiation and duration of first labour stage, duration (from the beginning of labour to initiation of the pushing phase), time of the second stage of labour (from the initiation of pushing time to the birth of the baby), foetal cardiac rhythm (FCR) alterations during labour, type of delivery (assisted or not) and variables of the third stage of labour (AMTSL, uterine revision, primary post partum haemorrhage occurrence, placenta weight). Moreover, variables in relation with the baby were studied: sex, weight, Apgar score at 1 and 5 minutes. Each factor were submitted to a univariate analysis. Multivariate analysis was carried only onto factors significant after univariate analysis. Analysis concerning volume was performed on all 3838 CBU while analysis for CD34+ cells content was performed only on CBU with a volume > 80 ml (minimum volume required for banking in our CBB)Results: In univariate analysis, assisted initiation of first stage of labour (p=0.04), FCR modification during labour (p=0.01), uterine revision (p=0.01), primary post partum haemorrhage (p=0.01), gestational stage (p=0.0001), duration of second stage labour (P=0.0001), placenta and baby weight (both p=0.0001) instrumental expulsion (p= 0.0001) and male baby (p=0.01) were associated with higher CBU volume. Conversely, AMSTL (p= 0.01) and Apgar sore at 1 and 5 minutes (p=0.0007 and 0.004 respectively) were associated with lower CBU volume. In multivariate analysis, only assisted initiation of first stage of labour (p=0.02), primary post partum haemorrhage (p=0.0001), duration of second stage labour (P=0.003), placenta and baby weight (both p=0.0001) were associated with higher CBU volume. However, AMSTL (p= 0.03) and Apgar sore at 1 (p=0.003) were associated with lower CBU volume. Concerning CD34+ cells, in multivariate analysis, only maternal age (p=0.02), gestational stage (p=0.0001), FCR modification during labour (p=0.001), duration of second stage labour (p=0.0001), placenta and baby weight (respectively p= 0.001 and p=0.0001) were associated with higher CD34+ cells content in CBU. Conversely, only Apgar sore at 1 (p=0.0001) was associated with lower CD34+ cells content in CBU.Conclusion: AMSTL is associated with a low CBU volume but not with a low CD34+ cell count. In view of the know generalized use of AMSTL, such findings could have on impact on the determination of volume and CD34+ cell content threshold required for CBU banking.