Timing Of Cord Clamping Research Articles

Effect of delayed cord clamping on cerebral tissue oxygen saturation in newborns

Objective To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes. Methods From November 2018 to February 2019, 164 healthy full term newborns were delivered in the Department of Obstetrics, Binhu Hospital, the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group, DCC groups for 1 minute, 2 minutes and 3 minutes according to the different cord clamping time, and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index(cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth. Results After birth, cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group, but there was no difference between group 3 and group 4.In ECC group, the cTOI tended to be stable about 6 minutes after birth, and the stable range was 55%-59%.In DCC group, group 2 tended to be stable about 8 minutes after birth, and the stable range was 59%-64%.Group 3 and group 4 tended to be stable about 10 minutes after birth, the stable range was 64%-69%.There was no difference in cTHI among the groups. Conclusions Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow, but the increase in brain oxygen content, and the optimal duration of DCC is 2 minutes. Key words: Delayed cord clamping; Cerebral tissue oxygen saturation; Cerebral tissue hemoglobin; Near infrared spectroscopy; Infant, newborn

Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.

Background Optimal timing for clamping the umbilical cord at preterm birth is unclear. Early clamping allows for immediate transfer of the infant to the neonatologist. Delaying clamping allows blood flow between the placenta, the umbilical cord and the baby to continue. The blood which transfers to the baby between birth and cord clamping is called placental transfusion. Placental transfusion may improve circulating volume at birth, which may in turn improve outcome for preterm infants. Objectives To assess the short- and long-term effects of early rather than delaying clamping or milking of the umbilical cord for infants born at less than 37 completed weeks' gestation, and their mothers. Search methods We searched the Cochrane Pregnancy and Childbirth Group Trials Register (31 May 2011). We updated this search on 26 June 2012 and added the results to the awaiting classification section. Selection criteria Randomised controlled trials comparing early with delayed clamping of the umbilical cord and other strategies to influence placental transfusion for births before 37 completed weeks' gestation. Data collection and analysis Three review authors assessed eligibility and trial quality. Main results Fifteen studies (738 infants) were eligible for inclusion. Participants were between 24 and 36 weeks' gestation at birth. The maximum delay in cord clamping was 180 seconds. Delaying cord clamping was associated with fewer infants requiring transfusions for anaemia (seven trials, 392 infants; risk ratio (RR) 0.61, 95% confidence interval (CI) 0.46 to 0.81), less intraventricular haemorrhage (ultrasound diagnosis all grades) 10 trials, 539 infants (RR 0.59, 95% CI 0.41 to 0.85) and lower risk for necrotising enterocolitis (five trials, 241 infants, RR 0.62, 95% CI 0.43 to 0.90) compared with immediate clamping. However, the peak bilirubin concentration was higher for infants allocated to delayed cord clamping compared with immediate clamping (seven trials, 320 infants, mean difference 15.01 mmol/L, 95% CI 5.62 to 24.40). For most other outcomes (including the primary outcomes infant death, severe (grade three to four) intraventricular haemorrhage and periventricular leukomalacia) there were no clear differences identified between groups; but for many there was incomplete reporting and wide CIs. Outcome after discharge from hospital was reported for one small study; there were no significant differences between the groups in mean Bayley II scores at age seven months (corrected for gestation at birth (58 children)). No studies reported outcomes for the women. Authors' conclusions Providing additional placental blood to the preterm baby by either delaying cord clamping for 30 to 120 seconds, rather than early clamping, seems to be associated with less need for transfusion, better circulatory stability, less intraventricular haemorrhage (all grades) and lower risk for necrotising enterocolitis. However, there were insufficient data for reliable conclusions about the comparative effects on any of the primary outcomes for this review.

Randomised trial of cord clamping at very preterm birth: outcomes at 2 years

ObjectiveTo report outcomes at 2 years corrected age for children of women recruited to a trial comparing alternative policies for timing of cord clamping and immediate neonatal care at very...

Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4weeks.

Our aim was to investigate the effects of timing of cord clamping on the risk of hyperbilirubinaemia. We recruited 540 normal vaginal deliveries at the Paropakar Maternity and Women's Hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. They were randomised into two groups: 257/270 were cord clamped within 60seconds and 209/270 after 180seconds. Transcutaneous bilirubin was measured at discharge and 24hours. At 4weeks, 506 mothers were successfully contacted by phone, and the health status of the baby and their history of jaundice and treatment was recorded. Based on transcutaneous bilirubin at discharge, 22/261 (8.4%) in the early group and 25/263 (9.5%) in the delayed group (P=0.76) were at high risk of subsequent hyperbilirubinemia. At the 4-week follow-up, jaundice was reported in 13/253 (5.1%) in the early and 17/253 (6.7%) in the delayed group (P=0.57) and 3/253 (1.2 %) of the early and 1/253 (0.4%) of the delayed group (P=0.62) received treatment. All analyses were based on intention-to-treat. Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia during the first day of life or risk of jaundice within 4weeks compared with the early group.

Optimal Timing and Methodology of Umbilical Cord Clamping in Preterm Infants: a Review

We examine current recommendations for the timing of umbilical cord clamping in term and preterm infants and review available literature in support of these recommendations. Additionally, we explore potential barriers to practice change and identify opportunities for ongoing research. Available literature supports the practice of delayed cord clamping (DCC) in neonates, with clear benefits over immediate cord clamping (ICC) when comparing both short- and longer-term outcomes. Additional studies suggest similar benefits may be conferred by the practice of umbilical cord milking (UCM). Despite recommendation updates, significant variability in practice surrounding the timing of umbilical cord clamping persists. DCC and UCM show definite advantages over ICC. Perceived risks associated with either practice may lead to decreased adherence to current practice recommendations. Additional studies comparing these two practices are warranted and might help to further delineate best practice guidelines or potentially identify populations better suited to one method vs the other. Further education regarding the benefits of DCC and UCM are needed to improve recommendation adherence.

Third stage of labour management practices: A secondary analysis of a prospective cohort study of Australian women and their associated outcomes

ObjectiveThis study aimed to describe practices used during the third stage of labour in a cohort of Australian women and explore clinical outcomes such as postpartum hemorrhage and clinical decision making associated with these practices. DesignThis study employed a prospective cohort design and reports a secondary analysis of a primary study that examined factors associated with PPH; specifically relating to third stage management practices. SettingIt was conducted in three linked sites, in Queensland, Australia: a regional hospital, rural hospital and a private-practising midwifery service. Data collected: type of third stage management chosen by the care provider, and why; use of uterotonic medications (including administration timing); determination of cord-clamp timing and why; and, use of controlled cord traction. ParticipantsConvenience sample of women birthing vaginally between October 2015 and April 2016 (n = 522). FindingsActive management was the most common self-reported third stage management practice across these birth settings despite local health service guidelines advocating modified active management for all births. Modified active third stage was associated with least risk of PPH; however considerable variation in modified active practices was evident, particularly relating to cord clamp timing and oxytocic administration. Professional discipline, birth setting and complications during labour were significantly associated with differences in third stage management. Midwives were more likely to engage in expectant management than obstetricians; while active management was more commonly used in the rural setting and when complications during labour were experienced. Key conclusionsModified active management was not associated with an increased risk of PPH consistent with contemporary evidence. However, a considerable proportion of providers may not be following evidence-based guidelines supporting modified active management which may be attributed to uncertainty around third stage practice definitions which has implications for education, practice, and policy. Implications for practiceDespite evidence-based guidelines, differences exist within modified active management including cord clamp timing, uterotonic administration and use of controlled cord traction. Modified active management was not associated with an increase in PPH.

Immediate effects of clamping of the umbilical cord on the newborns

Background: The optimal timing of cord clamping has been a controversial issue for decades. Most practitioners in developing countries clamp and cut the cord immediately after birth and this takes place during the third stage of labour. World Health Organization advises late cord clamping, however there is a debate on the optimal time for cord clamping. Delayed umbilical cord clamping appears to be beneficial for term and preterm infants.Methods: This observational study was undertaken at Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India from June 2018 to January 2019.Results: Total 100 neonates were studied of which 48 were females (48%) and 52 were males (52%). 76 babies (76%) were 3 day old in this study and 24 babies were (24%) 4 day old during the study period. 92 babies (92%) didn’t receive phototherapy in this study and 8 babies (8%) required phototherapy during the study period. No babies were polycythemic during this study period. Mean TB was 11.832 whereas mean DB was 0.5. Mean HCT was 56.332 and mean HB was 18.3002.Conclusions: Present study concluded that there are various advantages if authors practiced delayed cord clamping including higher levels of haemoglobin and haematocrit levels.

Effect of timing of umbilical cord clamping on maternal and neonatal outcomes: A protocol for systematic review and network meta-analysis.

Background:Umbilical cord clamping is one of the most commonly used medical or complementary medical interventions. The different timing of cord clamping may have any significant impact on public health. However, the results remain controversial. The aim of the study was to evaluate and compare the effect of different timing of umbilical cord clamping on maternal and neonatal outcomes.Methods:A systematic literature search for relevant articles will be conducted in the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Chinese Biomedical Literature Database from their inception to December 2018. Any randomized controlled trial (RCT), case-control study, observational study, that reported the effect of different timing of cord clamping will be included regardless of sample size. There are no language restrictions. Mortality and risk of iron-deficiency anemia will be used to assess the clinical effect. Risk of bias assessment of the included RCTs will be conducted by the Cochrane risk of bias tool and the Newcastle–Ottawa Scale is used to assess observational studies. All statistical analyses will be performed using Stata V.15.0. A modified version of Grades of Recommendation, Assessment, Development, and Evaluation will be used to assess the quality of evidence in network meta-analysis (NMA).Results:The results will be published in a peer-reviewed journal.Conclusion:This will be the first NMA to evaluate and compare the effect of different timing of umbilical cord clamping. We hope that the results of this NMA will help clinicians and caregivers make more appropriate choices when clamping umbilical cord.

The effects of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants.

To evaluate the effect of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants. Seventy-four infants between 34 and 41 weeks of gestation were included in the study. Of these, 37 were umbilical cord clamped immediately after birth and the remaining 37 were clamped after waiting one minute. Babies were divided into two groups as term and preterm. The prenatal, natal, postnatal characteristics of the infants were recorded. Hematologic and lymphocyte subgroups were investigated in cord blood and venous blood at day 7. Lymphocyte subgroups were evaluated using flow cytometry. With the delay of cord clamping, the leucocytes count and the percentage of CD3+T lymphocytes in cord blood of preterm infants decreased and this decrease continued at day 7. On the contrary, CD19+B lymphocyte levels in the cord blood of preterm infants increased, and this increase continued at day 7. Also, the percentage of CD4+T lymphocytes of preterm infants decreased with the delay of cord clamping at day 7. There was no difference between groups for the rate of sepsis development. With the delay of cord clamping, the leucocytes count, the percentage of CD3+T, and CD4+T lymphocytes decreased, and the percentage of CD19+B lymphocytes increased in preterm infants. The delay in cord clamping time in term and preterm infants seems to have no impact on the rate of sepsis development. Larger series of studies are needed to assess the effect of these findings on the development of infection in late preterm infants who have delayed cord clamping.

Cord pilot trial, comparing alternative policies for timing of cord clamping before 32\u2009weeks gestation: follow-up for women up to one year

BackgroundThe Cord Pilot Trial compared two alternative policies for cord clamping at very preterm birth at eight UK maternity units: clamping after at least 2 min and immediate neonatal care (if needed) with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports follow-up of the women by two self-completed questionnaires up to one year after the birth.MethodsWomen were given or posted the first questionnaire between four and eight weeks after birth, usually before their baby was discharged, and were posted a second similar questionnaire at one year. The questionnaire included the Hospital Anxiety and Depression Scale; the Preterm Birth Experience and Satisfaction Scale (P-BESS) and questions about their baby’s feeding.ResultsOf 261 women randomised (132 clamping ≥2 min, 129 clamping ≤20 s), six were excluded as birth was after 35+ 6 weeks (2, 4 in each group respectively). Six were not sent either questionnaire. The first questionnaire was given/sent to 244 and returned by 186 (76%) (79, 74%). The second, at one year, was sent to 242 and returned by 133 (55%) (66, 43%).On the first questionnaire, 89 (49%) had a score suggestive of an anxiety disorder, and 55 (30%) had a score suggestive of depression. Satisfaction with care at birth was high: median total P-BESS score 77 [interquartile range 68 to 84] (scale 17 to 85). There was no clear difference in anxiety, depression, or satisfaction with care between the two allocated groups. The median number of weeks after birth women breastfed/expressed was 16 (95% confidence interval (CI) 13 to 20, n = 119) for those allocated clamping ≥2 min and 12 (95% CI 11 to 16, n = 103) for those allocated clamping ≤20 s.ConclusionsThe response rate was higher for the earlier questionnaire than at one year. A high proportion of women reported symptoms of anxiety or depression, however there were no clear differences between the allocated groups. Most women reported that they had breastfed or expressed milk and those allocated deferred cord clamping reported continuing this for slightly longer.Trial registrationISRCTN 21456601, registered 28th February 2013, http://www.isrctn.com/ISRCTN21456601

Delayed cord clamping does not affect umbilical cord blood gas analysis.

Although delayed umbilical cord clamping has been shown to have significant benefits for both term and preterm infants, currently, data on its impact on blood gas analysis have been scant and conflicting. In a retrospective review, we compared the demographic characteristics and blood gas parameters of 114 delayed cord clamping (DCC-births between 45 and 90s in length; 109 being for 60s) versus 407 early cord clamping births (ECC-immediately after delivery) collected over a 1-year period. Intrapartum care and timing of cord clamping for individual cases were performed at the discretion of obstetricians. The differences were assessed for statistical and clinical significance. The DCC group was found to have significantly higher mean Apgar scores at both 1 and 5min (p < 0.05), as well as lower percentages of nulliparous births, cesarean-section deliveries, epidural anesthesia usage, and major pregnancy-related complications. No significant differences in maternal age, gestational age, neonate birthweight, sex, or in the presence of meconium at birth were observed. A higher umbilical artery pO2 in the DCC group [21 (9) vs. 19 (10) mmHg, p < 0.05] was the only statistically significant difference found out of all the blood gas parameters analyzed. In this study, infants selected for the DCC procedure were found to be overall lower risk than those delivered as per the standard ECC procedure. No clinically significant difference in any blood gas parameter was observed, and therefore, no adjustment to clinical reference intervals is needed for DCC blood gas samples taken after a 1-min delay period.

Effect of Delayed versus Early Cord Clamping on Neonatal Outcomes and Iron Status at 4 Months

Background: The optimal timing of umbilical cord clamping has been debated in the scientific literature for over a century. Early clamping of the umbilical cord is widely practised as part of the management of labour. Early clamping of the cord was one of the first routine medical interventions in labour. Its place in modern births was guaranteed by its incorporation into the triad of interventions that make up the active management of the third stage of labour. Babies who have immediate cord clamping have also been shown to be more likely to be anaemic, have decreased fine motor skills, and have decreased social skills during their first few years of age. Delayed umbilical cord clamping appears to have clear benefit for term infants. Delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first few months of life, which improve the developmental outcomes. There is growing evidence that delayed cord clamping is beneficial and can improve the infant’s iron status for up to 6 months after birth. For the first few minutes after birth, there is still circulation from the placenta to the infant. Waiting to clamp the umbilical cord for 2 - 3 min, or until cord pulsations cease, allows a physiological transfer of placental blood to the infant (placental transfusion), the majority of which occurs within 3 min. This placental transfusion provides sufficient iron reserves for the first 6 - 8 months of life, preventing or delaying the development of iron deficiency until other interventions. WHO’s findings suggest that late cord clamping (one to three minutes after delivery or longer) is recommended for all births. Aim of the study: 1) To evaluate the benefit of delayed cord clamping on the infant’s health status. 2) To assess hemoglobin, iron and ferritin at birth and at 4 months of age in infants who underwent early cord clamping (at 30 seconds) as compared with infants who underwent delayed cord clamping (at 60 seconds). Methods: A randomized controlled trial was conducted in Benghazi Medical Center and Elmgharif Hospital at Ejdabia. Study population was 256 women. The participants were randomized to delayed cord clamping or early cord clamping study groups. The data were checked manually for completeness, coded and analyzed by using Statistical Package for Social Sciences (SPSS). The incidence, relative risk, risk reduction, frequency percentage, mean, and standard deviation were used. Also t-test and chi sequare test (to test difference between means and proportions respectively) were used to compare between early and late cord clamping groups. Results: Two hundred forty seven participants completed the study (the attrition rate was 3.5%); 121 (49%) were control group (early cord clamping) and 126 (51%) were study group (delayed cord clamping) group. At birth no significant difference between two groups regarding the level of hemoglobin, iron and ferritin. At 4th month of age delayed cord clamping was associated with improved hemoglobin, iron and ferritin and that the incidence of anemia among infants who exposed to delayed cord clamping was 0.07, while the incidence of anemia among the infants who exposed to early cord clamping was 0.5. Conclusion: There was strong association between delayed umbilical cord clamping and improvement of iron indices and developmental mile stones in infants at 4th month of age.

The Effect of the Timing of Umbilical Cord Clamping on Hemoglobin Levels, Neonatal Outcomes and Developmental Status in Infants at 4 Months Old.

Delayed umbilical cord clamping (DCC) increases blood transfer to newborns. Hence we investigated the effect of the timing of DCC on hemoglobin levels, neonatal outcomes and developmental status in infants at four months old. This clinical trial examined infants born to 400 pregnant women immediately upon birth and at the age of four months in Isfahan, central Iran in 2016. A table of random numbers was used to randomly allocate the newborns to intervention group with a 90-120-sec delay in umbilical cord clamping and the control group with a clamping delay of below 60 sec, and blood samples were taken from their umbilical cords. The Ages and Stages Questionnaire was used to evaluate the infants' developmental status. Umbilical cord hemoglobin was significantly higher in the intervention group compared to in the controls (P=0.024). No significant differences were observed between the two groups in terms of neonatal complications except neonatal jaundice was significantly more common in the intervention group (P=0.025), although the need for phototherapy was not different between the groups. Overall, no significant differences were observed between the two groups in terms of developmental status at four months old; however, the infants had better problem-solving skills in the DCC group (P=0.015). Despite elevating hemoglobin, DCC has no effects on infant development except in terms of problem-solving skills. Further studies are recommended on the effects of DCC on infant development.

Italian Recommendations for Placental Transfusion Strategies.

At delivery, if the cord is not clamped, blood continues to pass from the placenta to the newborn during the first minutes of life, allowing the transfer of 25–35 ml/kg of placental blood to the newborn, depending on gestational age, the timing of cord clamping, the position of the infant at birth, the onset of respiration, and administration of uterotonics to the mother. However, deriving benefits from delayed cord clamping (DCC) are not merely related to placental-to-fetal blood transfusion; establishing spontaneous ventilation before cutting the cord improves venous return to the right heart and pulmonary blood flow, protecting the newborn from the transient low cardiac output, and systemic arterial pressure fluctuations. Recent meta-analyses showed that delayed cord clamping reduces mortality and red blood cell transfusions in preterm newborns and increases iron stores in term newborns. Various authors suggested umbilical cord milking (UCM) as a safe alternative when delayed cord clamping is not feasible. Many scientific societies recommend waiting 30–60 s before clamping the cord for both term and preterm newborns not requiring resuscitation. To improve the uptake of placental transfusion strategies, in 2016 an Italian Task Force for the Management of Umbilical Cord Clamping drafted national recommendations for the management of cord clamping in term and preterm deliveries. The task force performed a detailed review of the literature using the GRADE methodological approach. The document analyzed all clinical scenarios that operators could deal with in the delivery room, including cord blood gas analysis during delayed cord clamping and time to cord clamping in the case of umbilical cord blood banking. The panel intended to promote a more physiological and individualized approach to cord clamping, specifically for the most preterm newborn. A feasible option to implement delayed cord clamping in very preterm deliveries is to move the neonatologist to the mother's bedside to assess the newborn's clinical condition at birth. This option could safely guarantee the first steps of stabilization before clamping the cord and allow DCC in the first 30 s of life, without delaying resuscitation. Contra-indications to placental transfusion strategies are clinical situations that may endanger mother ‘s health and those that may delay immediate newborn's resuscitation when required.

Reducing Brain Injury of Preterm Infants in the Delivery Room.

Cerebrovascular injury is one of the major detrimental consequences of preterm birth. Recent studies have focused their attention on factors that contribute to the development of brain lesions immediately after birth. Among those factors, hypothermia and lower cerebral oxygen saturation during delivery room resuscitation and high tidal volumes delivered during respiratory support are associated with increased risk of severe neurologic injury. In preterm infants, knowledge about causes and prevention of brain injury must be applied before and at birth. Preventive and therapeutic approaches, including correct timing of cord clamping, monitoring of physiological changes during delivery room resuscitation using pulse oximetry, respiratory function monitoring, near infrared spectroscopy, and alpha EEG, may minimize brain injury, Furthermore, postnatal administration of caffeine or other potential novel treatments (e.g., proangiogenic therapies, antioxidants, hormones, or stem cells) might improve long-term neurodevelopmental outcomes in preterm infants.

Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: a feasibility study

ObjectivePhysiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to...

The Effects of Placental Transfusion on 12‐Month Brain Myelin Content in Term Infants: A Randomized Controlled Trial

IntroductionImmediate cord clamping (ICC) continues to be the standard practice in the United States. This results in leaving about 30% of the fetal‐placental iron‐rich blood behind in the placenta and puts an infant at risk for lower iron stores. Evidence (animal and human) suggests iron is critical to early brain white matter development as it plays a significant role in myelin formation. The purpose of this study was to determine, at 12 months of age, if infants who received a full placental transfusion at birth differ in myelin content and developmental outcomes compared to infants who received no placental transfusion. The hypothesis was that healthy, term infants who received a full placental transfusion via delayed cord clamping (DCC) will have greater brain myelin content and better neurodevelopmental outcomes compared to infants who received no placental transfusion (ICC) at 12 months of age.MethodsSeventy‐three term pregnant women with singleton fetuses were enrolled in a prospective randomized controlled trial and randomized to either ICC (&lt; 20 s) or DCC (≥ 5 min). At 4 and 12 months, the infants’ hemoglobin and ferritin levels were measured, and the infants underwent a non‐sedated MRI and neurodevelopmental testing.ResultsMaternal and infant demographics were not different between groups. Mean (SD) cord clamping time was 318 (158) seconds in the DCC group versus 10 (5) seconds in the ICC group (P &lt; .0001). At 4 months, infants who received DCC had higher ferritin levels (91 [57] vs 61 [30] ng/mL, P &lt; .04). At 12 months, infants randomized to DCC had significantly greater brain myelin content in the following brain regions: left and right (R) internal capsule, R parietal, R occipital, R frontal, and R orbital areas. The DCC group had a slightly higher social‐emotional performance than the ICC group using the BITSEA Competence score (17 [3] vs 15 [3], P = .08). No differences were seen in ferritin or hemoglobin levels between groups at 12 months.DiscussionAt 12 months, placental transfusion at birth appears to increase brain myelin content in regions involving motor and visual/spatial pathways and sensory processing. Neurodevelopmental testing suggests a trend of better social‐emotional outcomes associated with DCC. In conclusion, the endowment of iron‐rich blood obtained through DCC may offer a longitudinal advantage for early white matter development in the brain.

Knowledge and Practice of Umbilical Cord Clamping among Maternity Care Providers

Background & aim: Based on the current scientific evidence, delayed cord clamping (DCC) elevates early hemoglobin concentrations and iron stores in the neonate. However, the persistent practice of early cord clamping (ECC) is still a routine care. The aim of the present study was to investigate the umbilical cord clamping practices of maternity care providers in Oman. Methods: This cross-sectional study was conducted on 175 maternity care providers who were registered members of the Oman Society of Obstetricians and Gynecologists and participated voluntarily in the study. The data were collected using a modified version of an online survey in form of a questionnaire developed by Stoll and Hutton (2012). The data were analyzed using descriptive statistics. Results: According to the results, 61% and 31% of the participants were obstetricians and midwifes, respectively, with more than 10 years of experience. The findings indicated that the timing of cord clamping varied among the participants. 87.4-89.6% of the care providers considered ECC timing to be within 1 min of birth, and 70-72.6% of them clamped umbilical cord within 1 min for both normal term and preterm newborns. The most frequently listed benefits of DCC were the physiologic transitioning of the newborn, enhancement of neonatal iron stores, reduced risk of neonatal anemia, and decreased need for transfusions. 45.7% of the participants considered polycythemia and jaundice as the highest associated risks of DCC. Only 11% of the participants reported that they use hospital policy as a reference guide on decision making regarding the timing of cord clamping. Conclusion: Although the majority of the maternity care providers are aware of the new guidelines regarding the timing of cord clamping, they still follow ECC practice. The high prevalence of ECC highlighted the demand for the implementation of a nation- and hospital-wide policy.

Cellular Subsets of Maternal Microchimerism in Umbilical Cord Blood

Maternal microchimerism may arise in the offspring during pregnancy, and may be favorable or unfavorable. Additionally, maternal cells present in umbilical cord blood used for stem cell transplantation may affect the outcome after transplantation. The aim of this study was to evaluate the cellular subset and frequency of maternal cells in umbilical cord blood following vaginal deliveries and elective Cesarean sections where the umbilical cord clamping time was measured. A total of 44 healthy women with normal pregnancies were included in the study. Of these, 24 delivered vaginally and 20 by elective Cesarean sections. In the fresh umbilical cord blood, cellular subsets of CD3+ (T-cells), CD19+ (B-cells), CD33+ (myeloid cells), CD34+ (hematopoietic progenitor cells) and CD56+ (natural killer cells) cells were isolated and DNA extracted. A single-nucleotide polymorphism unique to the mother was identified and maternal microchimerism in the different cellular fractions was detected using quantitative real-time polymerase chain reaction with a sensitivity of 0.01%. Overall, 5 out of the 44 (11%) umbilical cord blood samples contained maternal microchimerism. The positive fractions were total DNA (whole blood, n = 3), CD34+ (n = 1), CD56+ (n = 1) and CD34+/CD56+ (n = 1). Overall, four of the five (80%) positive samples were from Cesarean sections and one was from a vaginal delivery. The conclusion from this study is that maternal microchimerism in umbilical cord blood is not a common phenomenon but includes both lymphoid and hematopoietic progenitor lineages.

Neonatal Outcomes in Cord Clamping; An Observational Study Highlighting the Correlation of Cord Clamping Time with Haematological Parameters

Objectives: The purpose of this study was to evaluate the neonatal outcomes in cord clamping and to find their correlation with different haematological parameters in neonates of Jinnah Postgraduate Medical Centre, Karachi Methodology: This was an observational study in which non-probability convenient sampling technique was used after taking ethical approval. The study was conducted on 342 pregnant women in the Obstetrics &amp; Gynaecology ward of Jinnah Postgraduate Medical Centre, Karachi, from 1st July 2016 to 31st December 2016.All the pregnant women from age of 25 to 45 years and without any haemolytic disease, with previous spontaneous vaginal deliveries, with a singleton pregnancy diagnosed via ultrasound during the first trimester and presenting in the 3rd stage of labour with a gestational age of ≥ 37weeks were included in the study. Soon after the delivery of placenta, the uterus was massaged either by patient herself or by the caretaker. Neonatal blood samples were gathered by the researcher through venipuncture following expulsion of the fetus and 24 hours after it and sent to the pathology laboratory of Jinnah Hospital for analysis. Data were analyzed in SPSS Version 20. Descriptive analysis was done. Pearson and Spearman tests were applied to see the correlation of cord clamping time. P-value of &lt; 0.05 was taken as significant. Results: A total of 342 pregnant females in their third stage of labor were selected for this study. No correlation existed between hemoglobin and hematocrit with cord clamping time (p-value 0.661) and (p-value 0.439) respectively. Weak positive correlation (p=0.002, r = 0.169) existed between billirubin levels with clamping time. No correlation was observed with cord clamping time and anemia, low hematocrit or polycythemia (p-value 0.422), (p-value 0.058) and (p-value 0.20) respectively while weak negative correlation (ρ = -0.221) existed between high bilirubin levels in neonates with increasing cord clamping time (p-value &lt; 0.001). Conclusion: According to our study, no correlation exists between hemoglobin and hematocrit with cord clamping time but weak positive correlation was observed between billirubin levels with clamping time in seconds. Keywords: cord clamping; correlation; haematological parameters