Abstract
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.
Highlights
Severe postpartum hemorrhage (PPH) is one of the most important contributors to maternal mortality, in low resource countries [1, 2]
The incidence of postpartum hemorrhage (26 [6.9%] vs. 35 (8.5%), odds ratio (OR) 1.24, 95% confidence interval (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
To reduce maternal blood loss, active management of the third stage of labor has been recommended by the World Health Organization (WHO) since 2007, it was already performed since the 1960s [2,3,4]
Summary
Severe postpartum hemorrhage (PPH) is one of the most important contributors to maternal mortality, in low resource countries [1, 2]. The placenta holds up to one-third of the total blood volume and immediate cord clamping would withhold this from the neonatal circulation [8]. Delayed cord clamping optimizes placental transfusion and results in a higher neonatal blood volume [1, 8, 9]. Performing delayed cord clamping for at least 3 min after birth should be considered in each healthy neonate [10, 11]. Immediate cord clamping appears to have a negative effect on cardiovascular adaptations occurring at birth that are better supported when the infant is still connected to the placenta [12, 13]. To assess maternal safety outcomes after a local protocol adjustment to change the interval of cord clamping to 3 min after term cesarean section
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