Maternal Safety Evaluation Following Implementation of Universal Delayed Cord Clamping [4R

Abstract

INTRODUCTION: In the term infant, there is evidence of delayed cord clamping (DCC) resulting in decreased anemia and improved cardiopulmonary adaptation. Despite the benefits, there are concerns regarding maternal safety, especially postpartum hemorrhage. This study evaluated the maternal safety outcomes following the departmental wide implementation of DCC. METHODS: A retrospective chart review was conducted of infants delivering between gestational age 34+0 weeks to 42+6 weeks. Outcomes were evaluated between the DCC and Immediate cord clamping (ICC) groups. Primary outcomes included estimated maternal blood loss (EBL) and hematocrit (Hct) decline following delivery. RESULTS: Of 817 deliveries, 763 (93%) underwent DCC. EBL for ICC group was 950 mL vs 300 mL in DCC group (<0.01 U); Hct decline was 6.2 vs 4.2 respectively (<0.01 t). 53% of the deliveries for the ICC were cesareans, while only 27% for the DCC. After controlling for mode of delivery, EBL in the vaginal delivery ICC group was 300 mL vs 300 mL in the DCC (P=.38); Hct decline was 3.1 and 3.7 (P=.76). In those undergoing cesareans, ICC EBL was 900 mL vs 1,000 mL (P=.93) for DCC; Hct decline 5.1 and 5.2 (0.92%). No blood transfusions in the vaginal delivery group. For those undergoing cesareans one (3.5%) transfusion was provided in the ICC group and 2 (1%) (P=.33) in the DCC group. CONCLUSION: Once controlling for mode of delivery there was no difference in primary maternal safety measures between the two groups. It is encouraged for Obstetricians to consider implementing universal DCC for all infants.