Timing Of Cord Clamping Research Articles

Influence of umbilical cord clamping time on cerebral oxygenation and early cardiac function in term infants.

Delayed cord clamping is the standard of care for both term and preterm infants worldwide. The aim of this study was to evaluate the effect of 60-second or 180-second delayed cord clamping during labor on cerebral oxygenation and cardiac function. Healthy newborns were divided into two groups: a 60-second delay in cord clamping (60-s DCC) and a 180-second delay in cord clamping (180-s DCC) at birth. Pulse oximetry and cerebral near-infrared spectroscopy (cNIRS) probes were placed during postnatal care. A total of 84 healthy newborns were included in this study. Preductal oxygen saturation (SpO2), heart rate, and cNIRS values were recorded at 5 and 10 minutes after delivery. The cardiac function of the infants was assessed by echocardiography at 3-7 days postnatally. There was no significant difference between the groups in SpO2 and cNIRS values at 5 and 10 min. While there was no significant difference in the number of neonates with targeted SpO2 at the 5th and 10th min and targeted cNIRS values at the 10th min, there was a significant difference in the number of neonates with target cNIRS values at the 5th min between groups (p < 0.001). Echocardiographic findings showed that pulmonary flow velocity was increased in the 180-s DCC group; the difference was statistically significant (p = 0.04). Our results showed that the number of infants with normal cNIRS values regarding cerebral oxygenation was higher in the 180-s DCC group. The pulmonary flow velocity was significantly increased in the 180-s DCC group in terms of echocardiographic findings.

Detection of time of birth and cord clamping using thermal video in the delivery room.

Newborn resuscitation algorithms emphasize that resuscitation is time-critical, and all algorithm steps are related to the time of birth. Infrared thermal video has the potential to capture events in the delivery room, such as birth, cord clamping, and resuscitative interventions, while upholding the privacy of patients and healthcare providers. The objectives of this concept study were to (i) investigate the technical feasibility of using thermal video in the delivery room to detect birth and cord clamping, and (ii) evaluate the accuracy of manual real-time registrations of the time of birth and cord clamping by comparing it with the accuracy of registrations abstracted from thermal videos. An observational study with data collected at Stavanger University Hospital, Norway, from September 2022 to August 2023. The time of birth and cord clamping were manually registered on a portable tablet by healthcare providers. Thermal cameras were placed in the delivery rooms and operating theatre to capture births. Videos were retrospectively reviewed to determine the time of birth and cord clamping. Participation consent was obtained from 306 mothers, of which 195 births occurred in delivery rooms or an operating theatre with a thermal camera installed. We excluded 12 videos in which no births occurred. Births were detectable in all 183 (100%) thermal videos evaluated. There was a median (quartiles) of 1.8 (0.7, 5.4) s deviation in the manual registrations of the times of births relative to those abstracted from thermal videos. Cord clamping was detectable in 173 of the 183 (95%) thermal videos, with a median of 18.3 (3.3, 108) s deviation in the manual registrations of the times of cord clampings relative to those abstracted from thermal videos. Recognizing the time of birth and cord clamping from thermal videos is technically feasible and provides a method for determining when resuscitative events occur.

Analyzing the Knowledge and Practices of Midwives in Turkey Regarding Cord Clamping Time

PURPOSE:This study aimed to evaluate the knowledge and practices of delivery room midwives on delayed cord clamping (DCC).METHOD:This descriptive study was conducted with a total of 1,274 delivery room midwives from five regions of Turkey between February 9, 2021 and September 26, 2022. The data were collected using a Google survey form.RESULTS:The highest cord clamping times of midwives ranged from 0 to 10 seconds in term and preterm newborns (34.7% and 54.8%, respectively). The rates of applying DCC were 17.6% and 5.3% in term and preterm newborns, respectively. Dealing with the mother, having a workload, considering that the newborn would have respiratory distress and get cold, preventing polycythemia and hyperbilirubinemia, and being afraid of dropping the newborn were the most common reasons for midwives not to apply DCC to newborns. The majority of the midwives reported that they had no DCC protocol in their institution (80.5%) and did not receive in-service training on DCC (76.5%).CONCLUSION:This study has concluded that most midwives who do not apply DCC correctly, have quite short cord clamping times, have no DCC protocol in their institutions, and do not receive in-service training.

Umbilical cord clamping: Midwife's perspective at one of the regional general Hospitals of Gorontalo Province

The incidence of iron deficiency anemia in infants is a problem that often occurs in all countries, especially in developing countries, which is caused by visible dan invisible blood loss, decreased red blood cell production, premature cell destruction, premature birth, LBW, small gestational age, maternal anemia dan time of umbilical cord clamping. Delaying cord clamping by 1-3 minutes allows blood flow between the placenta dan neonate to continue, which can improve iron status in the baby for up to six months after birth. In Indonesia, 62.7% of births are attended by midwives, so the midwife's perception plays an important role in deciding when to clamp the umbilical cord during childbirth care. Objectives: To determine the perception of midwives in one of the regional general hospitals of Gorontalo province regarding delays in clamping the umbilical cord. Methods: This research uses a qualitative method with a phenomenological approach. Data collection was carried out on 7 informants using in-depth interviews dan the results of the interviews were analyzed using thematic analysis. Results: There is a difference between the informant's perception dan the practice carried out by the informant regarding the delay in clamping the umbilical cord. Conclusion: This difference in perception is caused by the informant's education which is dominated by DIII level, less than optimal training, experience during work, dan the work environment.

Timing of Umbilical Cord Clamping in Preterm Neonates: A Randomized Controlled Trial

Background: The optimal timing for clamping the umbilical cord remains controversial. This study aimed to assess the optimal timing of umbilical cord clamping and its effect on preterm neonates. Methods: The study was a randomized controlled trial with the registration number: NCT06000800. It was conducted at Kasr Al Ainy Maternity Hospital, Cairo University Hospital, where a total of 80 pregnant women were randomly pooled and randomly divided into four groups with each group comprising 20 pregnant women. Umbilical cord clamping was performed in the first group immediately (5 sec after birth), after 30 sec in the second group, after 60 sec in the third group, and after 90 sec in the fourth group. After birth, clinical and laboratory parameters were assessed and recorded at the 1st, 6th, 12th, 24th, and 48th hours for all preterm neonates. Results: Delayed cord clamping at 90 sec was linked to improved preterm neonatal outcomes including heart rate at the 1st and the 6th hours; respiratory rate at the 12th hour; oxygen saturation at the 1st hour; hemoglobin, hematocrit, and blood glucose levels at the 6th, 12th, 24th, and 48th hours; but also linked to increase in bilirubin levels at the 12th, 24th, and 48th hours (P &lt; 0.001). There was no statistically significant difference concerning APGAR score; respiratory rate at the 12th hour, temperature at the 1st, 6th, 12th, 24th, and 48th hours; hemoglobin, hematocrit, and blood glucose at the 1st hour; and bilirubin at the 1st, 6th, and 12th hours in all groups (5, 30, 60, and 90 sec) (P &gt; 0.05). Conclusion: Better levels of blood glucose and hemoglobin were seen in preterm neonates whose cord clamping was delayed. Further studies should be carried out to determine the optimal timing of umbilical cord clamping with larger samples, for extended delay of clamping for more than 90 sec, and with recording of parameters for an extended period of follow-up even past the neonatal period.

Optimal Timing of Umbilical Cord Clamping: A Commentary on Recent Evidence

Commentary.

A Survey of Umbilical Cord Clamping Practices and Attitudes of Canadian Maternity Care Providers

Despite mounting evidence of the health benefits of delayed cord clamping of term and preterm neonates, Canadian practice guidelines about the optimal timing of cord clamping have not been developed. At the time the study was conducted, the Society of Obstetricians &amp; Gynecologists of Canada (SOGC) recommended early clamping as part of active management, while findings from several randomized controlled trials pointed at reported benefits of delayed cord clamping. It is unclear how Canadian maternity care providers were interpreting the evidence around umbilical cord clamping and what they do in clinical practice. A link to an online survey was distributed to members of the Canadian Association of Midwives (CAM) and the SOGC to assess maternity care providers’ umbilical cord clamping practices and attitudes. Respondents were asked to answer questions pertaining to the timing of cord clamping, reasons for cord clamping practices and perceived benefits and risks associated with delayed cord clamping (&gt; 60 seconds) for 1) term and 2) preterm infants (&lt; 37 weeks). A total of 353 respondents met eligibility criteria (i.e. they provided intrapartum care at the time of data collection). The majority of obstetricians (77.9%) reported clamping the cord of term infants immediately (&lt; 30 seconds), compared to 60.0% of family physicians and 9.8% of midwives; 6.5% of obstetricians, 9.1% of family physicians and 65.7% of midwives reported delaying cord clamping by two minutes or more. Midwives were more likely than physicians to make a conscious decision about the timing of cord clamping. Care providers reported higher rates of immediate cord clamping with preterm infants, compared to term infants, with 85% of physicians and 39% of midwives clamping the cord of preterm neonates within 30 seconds. The most common reason for clamping the cord of a term neonate immediately was the infants’ need for resuscitation or other medical interventions (79%). Personal routine was the most frequently cited reason for clamping the cord of a preterm infant immediately (40%). Findings from this survey highlight interprofessional variations in cord clamping practices. Clear practice guidelines around the optimal timing of cord clamping should be developed that take into considerations the health benefits of delaying cord clamping of term and preterm infants.

Blood pressure and cerebral oxygenation with physiologically-based cord clamping: sub-study of the BabyDUCC trial

BackgroundCord-clamping strategies may modify blood pressure (BP) and cerebral tissue oxygen saturation (rStO2) immediately after birth.MethodsWe conducted a sub-study nested within the Baby-Directed Umbilical Cord-Clamping trial. Infants ≥32+0 weeks’ gestation assessed as requiring resuscitation were randomly allocated to either physiologically-based cord clamping (PBCC), where resuscitation commenced prior to umbilical cord clamping, or standard care where cord clamping occurred early (ECC). In this single-site sub-study, we obtained additional measurements of pre-ductal BP and rStO2. In a separate observational arm, non-randomised vigorous infants received 2 min of deferred cord clamping (DCC) and contributed data for reference percentiles.ResultsAmong 161 included infants, n = 55 were randomly allocated to PBCC (n = 30) or ECC (n = 25). The mean (SD) BP at 3–4 min after birth (primary outcome) in the PBCC group was 64 (10) mmHg compared to 62 (10) mmHg in the ECC group, mean difference 2 mmHg (95% confidence interval −3–8 mmHg, p = 0.42). BP and rStO2 were similar across both randomised arms and the observational arm (n = 106).ConclusionWe found no difference in BP or rStO2 with the different cord clamping strategies. We report reference ranges for BP and rStO2 for late-preterm and full-term infants receiving DCC.ImpactAmong late-preterm and full-term infants receiving varying levels of resuscitation, blood pressure (BP, at 3–4 minutes and 6 min) and cerebral tissue oxygen saturation (rStO2) are not influenced by timing of cord clamping in relation to establishment of ventilation.Infants in this study did not require advanced resuscitation, where cord clamping strategies may yet influence BP and rStO2.The reference ranges for BP and rStO2 represent the first, to our knowledge, for vigorous late-preterm and full-term infants receiving deferred cord clamping.rStO2 > 90% (~90th percentile) may be used to define cerebral hyperoxia, for instance when studying oxygen supplementation after birth.

Physiological-based cord clamping in very preterm infants: the Aeration, Breathing, Clamping 3 (ABC3) trial—statistical analysis plan for a multicenter randomized controlled trial

BackgroundMortality, cerebral injury, and necrotizing enterocolitis (NEC) are common complications of very preterm birth. An important risk factor for these complications is hemodynamic instability. Pre-clinical studies suggest that the timing of umbilical cord clamping affects hemodynamic stability during transition. Standard care is time-based cord clamping (TBCC), with clamping irrespective of lung aeration. It is unknown whether delaying cord clamping until lung aeration and ventilation have been established (physiological-based cord clamping, PBCC) is more beneficial. This document describes the statistical analyses for the ABC3 trial, which aims to assess the efficacy and safety of PBCC, compared to TBCC.MethodsThe ABC3 trial is a multicenter, randomized trial investigating PBCC (intervention) versus TBCC (control) in very preterm infants. The trial is ethically approved. Preterm infants born before 30 weeks of gestation are randomized after parental informed consent.The primary outcome is intact survival, defined as the composite of survival without major cerebral injury and/or NEC. Secondary short-term outcomes are co-morbidities and adverse events assessed during NICU admission, parental reported outcomes, and long-term neurodevelopmental outcomes assessed at a corrected age of 2 years.To test the hypothesis that PBCC increases intact survival, a logistic regression model will be estimated using generalized estimating equations (accounting for correlation between siblings and observations in the same center) with treatment and gestational age as predictors. This plan is written and submitted without knowledge of the data.DiscussionThe findings of this trial will provide evidence for future clinical guidelines on optimal cord clamping management at birth.Trial registrationClinicalTrials.gov NCT03808051. Registered on 17 January 2019.

Impact of the Timing of Umbilical Cord Clamping on Maternal and Neonatal Outcomes in Saudi Arabia.

The optimal time for umbilical cord clamping after delivery has been under debate for several decades. This study aimed to assess the time-dependent effects of umbilical cord clamping on maternal and neonatal outcomes. An observational correlational design was used to recruit 161 pregnant women conveniently. Outcomes were observed and recorded using a structured checklist developed by the authors.Pregnant females aged ≥18 years, with uncomplicated delivery, and who were willing to participate were recruited. Exclusion criteria included stillbirths, newborns with congenital anomalies, newborns too small for their gestational age, intra-uterine growth restriction, nuchal cord, and meconium-stained liquor. The mean age of the participants was 29.93 ± 6 years. Early clamping (<1 minute) was performed for 93.8% of the participants with a mean of 29.58 ± 18 seconds. Delayed clamping was associated with a decrease in blood loss and the length of hospital stay in addition to an increase in first-minute APGAR score and neonatal temperature (P < 0.05). Delayed cord clamping was associated with improved maternal and neonatal outcomes.

Physiological-based cord clamping stabilised cardiorespiratory parameters in very low birth weight infants.

We investigated the influence of physiological-based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life. This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups. We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups. PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation.

Effect of Time of Cord Clamping on the Serum Bilirubin Level among Full‐Term Babies Born in an Ethiopian Hospital Setting: An Exploratory Three‐Arm Randomized Controlled Trial

Effect of Time of Cord Clamping on the Serum Bilirubin Level among Full‐Term Babies Born in an Ethiopian Hospital Setting: An Exploratory Three‐Arm Randomized Controlled Trial

Effect of Umbilical Cord Clamping time of Term Infants on Maternal and Neonatal Outcome

Effect of Umbilical Cord Clamping time of Term Infants on Maternal and Neonatal Outcome

'It must be right, I saw it on TV!': An observational study of third stage birth practices in popular television programmes.

To examine modern media depictions of the third stage of birth in a selection of UK television representations. Observational study of a sample of televised fictional and real births, audited against current National Institute of Health and Social Care Excellence (NICE) guidance. UK television channels BBC (Call The Midwife and This Is Going To Hurt) and Channel 4 (One Born Every Minute). 87 births from 48 episodes, sampled from the three shows. The primary outcome was the number of births where the cord was clamped at more than 1 min after birth. Secondary outcomes included place and type of birth, measures of dignity and paternal involvement. Overall, the timing of cord clamping was clearly shown in 25/87 (29%) of births, of which only 4/25 (16%) occurred at more than 1 min in screen time. The place of birth and caesarean section (CS) rate changed according to the series perspective and era; graphic explicit images were shown, but these related to CS detail. UK television shows have accurately depicted changes in place, culture and type of birth over the last century. They provide the public with a view of new rituals but an inaccurate picture of good quality care. Early cord clamping was shown in most births, even those set after 2014. No programme informed viewers about the safety aspects. When showing outdated practices, broadcasters have a public health duty to inform viewers that this is no longer recommended.

EFFECT OF EARLY VS. DELAYED CORD CLAMPING IN NEONATE'S HEART RATE AND OXYGEN SATURATION IN THE FIRST 10 MINUTES OF LIFE

The timing of umbilical cord clamping after birth can influence neonatal physiological parameters, which may affect immediate neonatal outcomes. This study sought to determine the effects of early cord clamping (ECC) and delayed cord clamping (DCC) on neonates' heart rate and oxygen saturation during the first ten minutes of life. The Obstetrics and Gynecology Department of Liaquat National Hospital, Karachi, carried out the randomized controlled trial with 200 participants. Two groups of newborns were assigned: ECC (cord clamped within 60 seconds of birth) and DCC (cord clamped after 60 seconds of birth). A pulse oximeter was used to monitor heart rate and oxygen saturation continuously from birth to 10 minutes of life. In most observed intervals, the heart rates of neonates in the DCC group fell within the range of 111 to 150 bpm. A significant proportion of ECC neonates had heart rates between 151 and 170 beats per minute at one minute. In addition, during the early postnatal period, DCC neonates consistently exhibited higher oxygen saturation levels, particularly within the 96-100% range, compared to ECC neonates. Delayed cord clamping appeared to promote stability in neonatal heart rate and enhance oxygen saturation in the immediate post-birth period. These findings highlighted the physiological advantages of DCC and its function in optimizing early neonatal outcomes.

A RIGOROUS EXAMINATION OF THE APPROPRIATENESS AND CONSEQUENCES OF DEFERRED CORD CLAMPING IN PRETERM BABIES

The timing of umbilical cord clamping is a pivotal decision in neonatal care, especially for preterm babies. Recent discussions have pivoted around the merits and drawbacks of Delayed Cord Clamping (DCC) compared to Immediate Cord Clamping (ICC). This study aimed to assess and contrast the implications of DCC versus ICC on clinical, respiratory, developmental, and maternal outcomes among preterm neonates. A multicentric, forward-looking, cross-sectional investigation was executed. The study encompassed 350 preterm neonates from various centers. They were categorically split: 175 underwent DCC, while the other 175 experienced ICC. Diverse outcomes, spanning clinical to maternal, were meticulously evaluated. DCC neonates demonstrated elevated early post-birth hemoglobin and hematocrit measurements. The DCC group reported reduced polycythemia occurrences, diminished transfusion necessities, and lesser demands for cardiovascular interventions. Regarding respiratory metrics, the DCC faction showed a decreased incidence of RDS. Neurodevelopmental indicators, such as cognitive and motor capabilities, were more pronounced in the DCC segment. The DCC group manifested reduced neonatal mortality rates and fewer sepsis cases. Maternally, post-delivery hemorrhage was comparable between groups, yet the DCC set displayed heightened satisfaction and a more pronounced initiation and continuity in breastfeeding. The evidence suggests that DCC may present multiple benefits over ICC for preterm neonates in terms of health and developmental outcomes. This underscores the potential of DCC as an integral component of best practices in neonatal care for premature babies.

Timing of umbilical cord occlusion, delayed vs early, in preterm babies: A randomized controlled trial (CODE-P Trial)

IntroductionOur hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30–60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage. Material and methodsA prospective, open-label, randomized, controlled trial was conducted at Vall d’Hebron Hospital from July 2014 to December 2018. All pregnant women at risk of impending preterm birth (≥26.0-<33.0 weeks of gestation) who were admitted to the obstetrics emergency department were evaluated for eligibility. If they met the eligibility criteria, they were invited to participate in the study and, if they agreed, they signed an informed consent. Patients were randomly assigned to one of two groups: ECC group and DCC group. ResultsOur study included a total of 57 patients: 30 in the ECC group and 27 in the DCC group. Due to a lack of funding and low recruitment rates, the study was discontinued in 2018. Maternal characteristics and obstetric outcomes were similar between both groups. The intention-to-treat analysis did not reveal any differences between groups for neonatal red blood cell transfusions, neonatal IVH or maternal postpartum haemorrhage. There were no differences for secondary outcomes. Similarly, no differences were observed in the as-treated analysis. ConclusionThe primary and secondary outcomes of our study were not achieved. Therefore, more meta-analysis and trials are needed to evaluate the appropriate timing of cord clamping in preterm birth.

PD01 First UK report of pregnancy and childbirth in X-linked erythropoietic protoporphyria

Abstract X-linked erythropoietic protoporphyria (XLEPP), an exceptionally rare form of cutaneous porphyria, is characterized by significant acute painful photosensitivity and a risk of both reduced bone mineral density and protoporphyric hepatopathy that may progress to liver failure. Diagnosis requires demonstration of significantly elevated red cell total porphyrins consisting of both zinc and free protoporphyrin analysed on venous whole blood. As the condition is X-linked, any offspring of an affected woman has a 50% chance of inheriting the disease-causing ALAS2 gain-of-function mutation. There are no reported cases of pregnancy in XLEPP in the literature, and no published experience of managing newborn infants that may have inherited XLEPP who develop neonatal jaundice, which requires treatment with phototherapy. Here we describe the clinical course of a 29-year-old woman with XLEPP (part of a four-generation XLEPP family) and idiopathic thrombocytopenia during pregnancy—the first documented case in the UK, to our knowledge. A multiprofessional team considered the potential risks posed by XLEPP and idiopathic thrombocytopenia for the pregnancy, birth and newborn. Haematological and biochemical indices were monitored throughout the pregnancy. The mother experienced increased photosensitivity and worsening idiopathic thrombocytopenia during the pregnancy, the majority of which occurred over summer. Idiopathic thrombocytopenia did not respond to treatment with steroids and immunoglobulin, necessitating a general anaesthetic for the planned caesarean section. A male infant was born in good condition at term. Maternal blood loss was only just above average. The baby remained well in the immediate postnatal period. Although the baby did not require treatment for jaundice, management planned in advance included minimizing factors predisposing to jaundice, including optimal timing of cord clamping and early feed support, the urgent analysis of cord blood erythrocyte porphyrins within 24 h, using a light-emitting diode phototherapy device with narrow spectrum emission between 450 and 470 nm and minimal emission at 400 nm, monitoring the baby closely for signs of distress and skin changes, and considering adjustment of the phototherapy thresholds or using alternative treatments should jaundice occur. Cord blood erythrocyte total porphyrin results suggested the baby had inherited XLEPP and would be photosensitive. This was later confirmed by mutation analysis.

Midwifery care providers' childbirth and immediate newborn care competencies: A cross-sectional study in Benin, Malawi, Tanzania and Uganda.

Evidence-based quality care is essential for reducing sub-Saharan Africa's high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment. We assessed midwifery care providers' ability to provide quality intrapartum and newborn care and selected aspects of the working environment as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire to assess provider knowledge and their working environment and skills drills simulations to assess skills and behaviours. All midwifery care providers including doctors providing midwifery care in the maternity units were invited to take part in the knowledge assessment and one third of the midwifery care providers who took part in the knowledge assessment were randomly selected and invited to take part in the skills and behaviour simulation assessment. Descriptive statistics of interest were calculated. A total of 302 participants took part in the knowledge assessment and 113 skills drills simulations were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. Over half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn, while higher scores were achieved in active management of the third stage of labour. The assessment also identified a lack of involvement of women in clinical decision-making. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly related to the structural and operational facility characteristics including continuing professional development. Investment and action on these findings are needed when developing and designing pre-service and in-service training. Trial registration: PACTR202006793783148-June 17th, 2020.

The effect of cord clamping time on cord blood gas in term newborn babies delivered by cesarean section

Objective: Umbilical cord clamping time is a situation that should be planned before delivery. It is recommended that the umbilical cord be clamped for at least 30–60 seconds after birth in healthy preterm and term newborns. There are few studies investigating the effect of umbilical cord clamping time on cord blood gas. If the umbilical cord is clamped before 30 seconds after birth, it is considered early clamping, and if it is clamped after 30 seconds, it is considered late clamping. In this study, we aimed to compare the early or late clamping time of the umbilical cord with the acid-base parameters and lactate values of babies. Methods: A total of 217 term newborn infants who were delivered by cesarean section between December 2020 and December 2021 in our hospital, whose umbilical cord clamping times were recorded and who had cord blood samples, were included in our study retrospectively. pH, pCO2, pO2, HCO3, BE, lactate, Hb and bilirubin values in cord blood gas samples were compared between the two groups. Results: Two hundred seventeen term newborn babies were included in the study. Cord clamping time of infants was delayed in 125 (57.6%) and early in 92 (42.4%) infants. The mean pH in cord blood gas was 7.37±0.07 (7.16–7.57), pCO2 was 39.73 ±8.97 (20.3–65.4) mmHg, pO2 was 53.42±41.95 (14.8–198) mmHg, BE was -2.18±2.90 (-11.9–13.6) mmol/L, lactate was 2.12±0.88 (0.50–5.90) mmol/L, Hb was 14.57± 2.54 (10–23.7) g/dl, and bilirubin was 1.71±1.33 (0–3.7) mg/dl. Conclusion: There was no significant relationship between early and late clamping of the umbilical cord and acid-base parameters, and hemoglobin values in cord blood gas in term newborn babies delivered by cesarean section.