Early Cord Clamping Research Articles

Association between oxidative stress and cord serum lipids in relation to delayed cord clamping in term neonates

BackgroundAlthough delayed cord clamping (DCC) is a recent WHO recommendation, early cord clamping (ECC) is still a routine practice in many countries. Limited researches studied the effect of delayed cord clamping on oxidative stress in term neonates; In this study we aim to assess the influence of cord clamping either early or late on oxidative stress in term neonates and to evaluate the association of oxidative stress and cord blood lipids.MethodsOne-hundred mothers and their term neonates were included in the present study. Umbilical cord blood samples were collected from the umbilical vein and umbilical artery immediately following labor.ResultsTotal cholesterol, total triglycerides and phospholipids levels were significantly higher in the ECC group than the DCC group (p < 0.001 in all). Plasma total antioxidant status was higher in the DCC group than the ECC group (p < 0.001). While, plasma hydroperoxides were lower in the DCC group than the ECC group (p < 0.001). Levels of erythrocytes catalase cytosol, superoxide dismutase and glutathione peroxidase were significantly higher in the DCC group than the ECC group (p < 0.001).ConclusionDCC was associated with a decrease in cord blood lipids and an augmented antioxidant activity. This suggests the protective effect of DCC on the future health of the term neonates and supports the application of DCC in active management of 3rd stage of labor in term neonates.

Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30–33 weeks Gestation

To assess the effect of placental transfusion by delayed cord clamping (DCC) of 60s or cord milking (CM) on serum ferritin levels at hospital discharge and 3 mo of postmenstrual age (PMA) in preterm neonates of 30 to 33 wk gestation in comparison to early cord clamping (ECC) within 10s. This mixed longitudinal study was conducted in moderately preterm neonates of 30 to 33 wk gestation born in a level III unit in Northern India with the study sample nested within a randomized controlled trial on placental transfusion. Intervention was delayed cord clamping for 60s or cord milking compared with early cord clamping (within 10s). Primary outcome measure was serum ferritin levels at discharge. Secondary outcome measures were serum ferritin levels at 3 mo PMA, incidence of anemia, need for blood transfusion and incidence of iron deficiency by 3 mo PMA. Out of the 215 randomly chosen infants, serum ferritin levels were estimated at least at one time point (at discharge or at 3 mo PMA) in 197 neonates [placental transfusion - 107; early cord clamping - 90]. Amongst them, ferritin level was estimated at discharge in 141 neonates, at 3 mo PMA in 76 neonates and at both time points in 20 neonates. Median (IQR) serum ferritin (μg/L) at discharge was significantly higher in placental transfusion group in comparison to the ECC group [399 (309,600) (n = 79) vs. 254 (190,311) (n=62); p<0.001]. Median (IQR) ferritin level at 3 mo PMA was not different between the study groups [20 (14,57) (n= 39) vs. 24 (8,52) (n=37); p=0.2]. The incidence of anemia by 3 mo PMA was significantly lesser in the placental transfusion group. No difference was observed in anemia requiring blood transfusion and iron deficiency by 3 mo PMA between the groups. In 30 to 33 wk preterm neonates, placental transfusion resulted in significantly higher serum ferritin at discharge in comparison to early cord clamping. However, this benefit did not persist till 3 mo PMA.

Delayed cord clamping and cord gas analysis at birth.

Delayed cord clamping for at least 60s in both term and preterm babies is a major recent change in clinical care. Delayed cord clamping has several effects on other possible interventions. One of these is the effect of delayed cord clamping on umbilical artery gas analysis. When indicated, umbilical artery gas analysis can safely be done either with early cord clamping or, probably most of the times it is necessary, during delayed cord clamping with the cord still unclamped. Paired blood samples (one from the umbilical artery and one from the umbilical vein) can be taken from the pulsating and unclamped cord, immediately after birth, during delayed cord clamping, without any effect on either the accuracy of umbilical artery gas analysis or the transfusion of blood through delayed cord clamping. Umbilical artery gas analysis should instead not be done after delayed cord clamping, since delayed cord clamping alters several acid-based parameters and lactate values.

Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis

The effects of delayed cord clamping of the umbilical cord in preterm infants are unclear. We sought to compare the effects of delayed vs early cord clamping on hospital mortality (primary outcome) and morbidity in preterm infants using Cochrane Collaboration neonatal review group methodology. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles, cross-referencing citations, expert informants, and trial registries to July 31, 2017, for randomized controlled trials of delayed (≥30 seconds) vs early (<30seconds) clamping in infants born <37 weeks' gestation. Before searching the literature, we specified that trials estimated to have cord milking in >20% of infants in any arm would be ineligible. Two reviewers independently selected studies, assessed bias, and extracted data. Relative risk (ie, risk ratio), risk difference, and mean difference with 95% confidence intervals were assessed by fixed effects models, heterogeneity by I2 statistics, and the quality of evidence by Grading of Recommendations, Assessment, Development, and Evaluations. Eighteen randomized controlled trials compared delayed vs early clamping in 2834 infants. Most infants allocated to have delayed clamping were assigned a delay of ≥60 seconds. Delayed clamping reduced hospital mortality (risk ratio, 0.68; 95% confidence interval, 0.52-0.90; risk difference, -0.03; 95% confidence interval, -0.05 to -0.01; P= .005; number needed to benefit, 33; 95% confidence interval, 20-100; Grading of Recommendations, Assessment, Development, and Evaluations= high, with I2= 0 indicating no heterogeneity). In 3 trials in 996 infants ≤28 weeks' gestation, delayed clamping reduced hospital mortality (risk ratio, 0.70; 95% confidence interval, 0.51-0.95; risk difference, -0.05; 95% confidence interval, -0.09 to -0.01; P=.02, number needed to benefit, 20; 95% confidence interval, 11-100; I2= 0). In subgroup analyses, delayed clamping reduced the incidence of low Apgar score at 1 minute, but not at 5 minutes, and did not reduce the incidence of intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late onset sepsis or retinopathy of prematurity. Delayed clamping increased peak hematocrit by 2.73 percentage points (95% confidence interval, 1.94-3.52; P < .00001) and reduced the proportion of infants having blood transfusion by 10% (95% confidence interval, 6-13%; P < .00001). Potential harms of delayed clamping included polycythemia and hyperbilirubinemia. This systematic review provides high-quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants. This review does not evaluate cord milking, which may also be of benefit. Analyses of individual patient data in these and other randomized controlled trials will be critically important in reliably evaluating important secondary outcomes.

Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

Background: One of the benefits of delayed cord clamping is a reduction in the rate of intraventricular hemorrhage. The findings in this regard are controversial and some negative effects of the procedure have been reported. Objectives: The purpose of this study was to investigate the effects of delayed cord clamping on intraventricular hemorrhage in preterm infants. Methods: This clinical trial was carried out on 70 preterm neonates delivered via cesarean section. Their gestational age was less than 32 weeks and the birth weight less than 1500 grams. Neonates were randomly assigned to two groups of early cord clamping (less than 10 seconds) or delayed clamping of the umbilical cord (30 - 45 seconds after birth). 3 to 7 days after birth, presence of Intraventricular hemorrhage (IVH) in both groups was checked by ultrasonography (Mindray machine, model m7) and. Rate and severity of IVH was compared between the two groups. Results: There was no significant difference in mean gestational age, birth weight, gender distribution and medications in both groups of delayed cord clamping and early clamping of the umbilical cord. The incidence of seizures in the early clamping was 8.6% and in the delayed clamping zero (P = 0.239). The incidence rate of IVH and periventricular leukomalacia (PVL) was 11.43% and 5.7%, respectively in the early clamping, while this rate was zero in the delayed clamping group. This difference was not statistically significant in both indicators (P = 0.12 and P = 0.493, respectively). Conclusions: The results showed that intraventricular hemorrhage in premature neonates with delayed clamping was less prevalent than those with early clamping, and may be used as a reliable method.

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Objective: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection.Design: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4+ count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants.Methods: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively.Results: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p = .05): this difference persisted at 1 month of life. All newborns showed negative viral load.Conclusions: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia.

Lotus birth, a holistic approach on physiological cord clamping

The positive effects of delayed cord clamping (DCC) has been extensively researched. DCC means: waiting at least one minute after birth before clamping and cutting the cord or till the pulsation has stopped. With physiological clamping and cutting (PCC) the clamping and cutting can happen at the earliest after the pulsation has stopped. With a Lotus birth, no clamping and cutting of the cord is done. A woman called Clair Lotus Day imitated the holistic approach of PCC from an anthropoid ape in 1974. The chimpanzee did not separate the placenta from the newborn. The aim of this case report is to discuss and learn a different approach in the third stage of labour. Three cases of Lotus birth by human beings were observed. All three women gave birth in an out-of-hospital setting and had ambulant postnatal care. The placenta was washed, salted and herbs were put on 2-3h post partum. The placenta was wrapped in something that absorbs the moisture. The salting was repeated with a degreasing frequency depending on moistness of the placenta. On life day six all three Lotus babies experiences a natural separation of the cord. All three Lotus birth cases were unproblematic, no special incidence occurred. One should differentiate between early cord clamping (ECC), delayed cord clamping (DCC) and physiological cord clamping (PCC). Lotus birth might lead to an optimisation of the bonding and attachment. Research is needed in the areas of both PCC and Lotus birth.

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Background: Recent protocol proposed by the World Health Organization to manage the third stage of labour replaced the early cord clamping by deferred cord clamping to induce numerous neonatal benefits. But this practice is still resisted in most of the Arab countries. The aim of this study was to evaluate the effectiveness of deferred versus early umbilical cord clamping on maternal and neonatal outcomes. Methods: A quasi experimental research design was utilized. The study was conducted at labour unit in Damanhour National Medical Institute. Sample: A convenience sample of 150 parturient women undergoing normal vaginal delivery were randomly divided in two groups; deferred cord clamping (n= 75) and early cord clamping (n= 75). Tools: Three tools were used for data collection; 1) Structured interview schedule to collect data about the women' demographic characteristics and reproductive history. 2) Maternal outcomes assessment sheet. 3) Neonatal outcomes assessment sheet to assess the immediate and late neonatal outcomes. Results: There were no statistically significant differences (P > 0.05) between deferred and early cord clamping groups in relation to the maternal risk for post-partum hemorrhage, duration of third stage of labour and the need for manual removal of the placenta. Furthermore, a highly statistically significant differences (p Conclusion: The study concluded that deferred umbilical cord clamping did not increase the risk of maternal post-partum hemorrhage, duration of third stage of labour or the need for manual removal of the placenta. Also, deferred cord clamping significantly increased neonatal hemoglobin, hematocrit, and red blood cells level without serious elevation in the total bilirubin level as it was still in the low intermediate risk or below 75th percentile. Recommendation: Institutionalization of deferred cord clamping in all governmental hospitals and medical educational settings through providing policies, procedures and guidelines regarding this practice. This could significantly improve the intra-natal care for the neonate without harmful consequences for the mother.

Timing of umbilical cord clamping of term infants.

For at least over 200 years, multiple controversies have arisen around the timing of umbilical cord clamping. In the past decades, early cord clamping (within the first 15 seconds) had markedly prevailed. Only in the 21st century, randomized controlled trials have demonstrated the benefits of delayed cord clamping (at 2-3 minutes). Delayed cord clamping has been practiced in obstetrics based on the recommendations made by scientific societies and in systematic reviews, which have provided solid evidence to support this practice in term infants. This review describes the most relevant factors supporting the use of delayed cord clamping in term infants. It points out the essential role played by physiological mechanisms which, undoubtedly, allow us to understand the benefits of delayed cord clamping and advise us to wait for what nature has established. Other relevant aspects supporting delayed cord clamping are also described here.

Is early cord clamping, delayed cord clamping or cord milking best?

Purpose: To compare the antioxidant status of three cord clamping procedures (early clamping, delayed clamping and milking) by analyzing the thiol–disulfide balance.Patients and methods: This randomized controlled study enrolled 189 term infants who were divided into three groups according to the cord clamping procedure: early clamping, delayed clamping and milking. Blood samples were collected from the umbilical arteries immediately after clamping, and the thiol/disulfide homeostasis was analyzed.Results: The native and total thiol levels were significantly (p < .05) lower in the early cord clamping group compared with the other two groups. The disulfide/total thiol ratio was significantly (p = .026) lower in the delayed cord clamping and milking groups compared with the early clamping groups. Early cord clamping causes the production of more disulfide bonds and lower thiol levels, indicating that oxidation reactions are increased in the early cord clamping procedure compared with the delayed cord clamping and milking procedures.Conclusion: The oxidant capacity is greater with early cord clamping than with delayed clamping or cord milking. Delayed cord clamping or milking are beneficial in neonatal care, and we suggest that they be performed routinely in all deliveries.

Maternal outcomes following the initiation of an institutional delayed cord clamping protocol: an observational case–control study

Objective: The objective of this study is to evaluate maternal outcomes before and after implementation of an institutional delayed cord clamping (DCC) protocol.Study design: We performed a secondary analysis of a retrospective cohort study of deliveries occurring at <34 weeks at a tertiary care center in 2013–2014. About 139 women who underwent early cord clamping were compared with 130 women delivered after DCC protocol implementation. Maternal estimated blood loss (EBL) was the primary outcome of interest. Operative times, post-Cesarean decrease in hemoglobin (Hgb), and rates of post-partum hemorrhage and transfusion were also examined in bivariate and multivariable analyses.Results: About 75% of post-guideline deliveries had actual DCC. In regression analyses, only Cesarean delivery and multifetal gestation increased EBL. No trends were identified in EBL over time. In post-hoc analysis, the study had over 80% power to detect a difference in post-partum hemorrhage rates of 20%.Conclusion: An institutional DCC protocol for deliveries <34 weeks was not associated with an identifiable increase in adverse maternal outcomes.

Effect of Delayed Cord Clamping on Hematocrit, and Thermal and Hemodynamic Stability in Preterm Neonates: A Randomized Controlled Trial.

To evaluate the short term clinical effects of delayed cord clamping in preterm neonates. Randomized controlled trial. A tertiary care neonatal unit from October 2013 to September 2014. 78 mothers with preterm labor between 27 to 316/7 weeks gestation. Early cord clamping (10 s), delayed cord clamping (60 s) or delayed cord clamping (60 s) along with intramuscular ergometrine (500 µg) administered to the mother. Primary: hematocrit at 4 h after birth; Secondary: temperature on admission in neonatal intensive care unit, blood pressure (non-invasive) at 12 h, and urinary output for initial 72 h. Mean (SD) hematocrit at 4 h of birth was 58.9 (2.4)% in delayed cord clamping group, and 58.7 (2.1) % in delayed cord clamping with ergometrine group as compared to 47.6 (1.3) % in early cord clamping group. Mean (SD) temperature on admission in NICU was 35.8 (0.2)ºC, 35.8 (0.3)ºC, and 35.5 (0.3)ºC, respectively in these three groups. The mean (SD) non-invasive blood pressure at 12 h of birth was 45.8 (7.0) mmHg, 45.8 (9.0) mmHg, and 35.5 (8.6) mmHg, respectively in these three groups. Mean (SD) urinary output on day 1 of life was 1.1 (0.2) mL/kg/h, 1.1 (0.2) mL/kg/hr and 0.9 (0.2) ml/kg/h, respectively. In preterm neonates delayed cord clamping along with lowering the infant below perineum or incision site and administration of ergometrine to mother has significant benefits in terms of increase in hematocrit, higher temperature on admission, and higher blood pressure and urinary output during perinatal transition.

Effects of Delayed Umbilical Cord Clamping vs Early Clamping on Anemia in Infants at 8 and 12 Months

Delayed umbilical cord clamping has been shown to improve iron stores in infants to 6 months of age. However, delayed cord clamping has not been shown to prevent iron deficiency or anemia after 6 months of age. To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on hemoglobin and ferritin levels at 8 and 12 months of age in infants at high risk for iron deficiency anemia. This randomized clinical trial included 540 late preterm and term infants born vaginally at a tertiary hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. Follow-up included blood levels of hemoglobin and ferritin at 8 and 12 months of age. Follow-up was completed on December 11, 2015. Analysis was based on intention to treat. Infants were randomized to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤60 seconds after delivery). Main outcomes included hemoglobin and anemia levels at 8 months of age with the power estimate based on the prevalence of anemia. Secondary outcomes included hemoglobin and anemia levels at 12 months of age and ferritin level, iron deficiency, and iron deficiency anemia at 8 and 12 months of age. In this study of 540 infants (281 boys [52.0%] and 259 girls [48.0%]; mean [SD] gestational age, 39.2 [1.1] weeks), 270 each were randomized to the delayed and early clamping groups. At 8 months of age, 212 infants (78.5%) from the delayed group and 188 (69.6%) from the early clamping group returned for blood sampling. After multiple imputation analysis, infants undergoing delayed clamping had higher levels of hemoglobin (10.4 vs 10.2 g/dL; difference, 0.2 g/dL; 95% CI, 0.1 to 0.4 g/dL). Delayed cord clamping also reduced the prevalence of anemia (hemoglobin level <11.0 g/dL) at 8 months in 197 (73.0%) vs 222 (82.2%) infants (relative risk, 0.89; 95% CI, 0.81-0.98; number needed to treat [NNT], 11; 95% CI, 6-54). At 8 months, the risk for iron deficiency was reduced in the delayed clamping group in 60 (22.2%) vs 103 (38.1%) patients (relative risk, 0.58; 95% CI, 0.44-0.77; NNT, 6; 95% CI, 4-13). At 12 months, delayed cord clamping still resulted in a hemoglobin level of 0.3 (95% CI, 0.04-0.5) g/dL higher than in the early cord clamping group and a relative risk for anemia of 0.91 (95% CI, 0.84-0.98), resulting in a NNT of 12 (95% CI, 7-78). Delayed cord clamping reduces anemia at 8 and 12 months of age in a high-risk population, which may have major positive effects on infants' health and development. clinicaltrials.gov Identifier: NCT02222805.

Uterotonics for post-partum haemorrhage

The active management of the third stage of labour has been defined as the interval between the birth of the neonate and expulsion of the placenta, with the use of an oxytocic drug administered immediately after birth, early cord clamping and cutting, and controlled cord traction ( Deneux-Tharaux et al, 2013 ). Synthetic uterotonics are designed to stimulate contraction of the uterus, in order to prevent post-partum haemorrhage (PPH), as uterine atony accounts for 90% of primary PPH in woman globally ( Say et al, 2014 ). Oxytocin, Syntometrine, ergometrine, and misoprostol, remain the front line drug therapies used to prevent and manage this complication.

An Audit of the Knowledge and Practice of the Active Management of the Third Stage of Labor in a Resource Constrained Setting

Background: The high incidence of post-partum haemorrage (PPH) in South Africa draws into question the knowledge and practice of HCPs with regard to AMTSL. Hence we carried out this assessment of HCPs knowledge and practice of AMTSL in the Pietermaritzburg Metropolitan Area (PMB). Aim: To evaluate HCP’s knowledge and practice of AMTSL in the Pietermaritzburg Metropolitan Area and to determine if AMTSL is being correctly implemented. Method: A cross sectional questionnaire based survey of 280 HCPs involved in maternity services, at a tertiary, regional and district hospital and 3 clinics. Results: 94% of questionnaires were completed by HCPs, 52.2% being midwives and 47.8% doctors. 71.2% of midwives and 71.1% of the doctors defined AMTSL according to the FIGO/WHO definition, with 93% of midwives and 91.9% of doctors practising AMTSL. Manual removal of the placenta was incorrectly listed as a part of AMTSL by 60.3% of midwives and 50.5% of the doctors. 64% of midwives and 42.3% of doctors incorrectly thought that the routine administration of a uterotonic agent was part of expectant management of the third stage of labour (EMTSL). Early cord clamping was practised by 69% of midwives and 73.8% of doctors, while 92% of midwives and 82.8% of doctors delivered the placenta by controlled cord traction. At caesarean delivery 65% of obstetric doctors and 87% of anaesthetic doctors use oxytocin (as a combination dose of intravenous bolus and infusion). Conclusion: This study highlights that while there is a deficiency in the knowledge and practice of the HCPs with regard to AMTSL in our setting, the majority do practise AMTSL, with most of the recommended components being implemented.

Effect of Early and Late Clamping of the Umbilical Cord on the Newborns Blood Analysis

Background: At the time of birth, the infant is still attached to the mother via the umbilical cord, which is a part of the placenta. The infant is usually separated from the placenta by clamping the cord. Timing of umbilical cord clamping has been and still is a highly controversial issue worldwide, the controversy about the best time to clamp the cord. The main aim of the study is to identify the effect of early and late cord clamping on newborns’ blood analysis. Hypothesis: The researcher hypothesized that the delayed cord clamping (1-3 minutes) after birth will make a difference on newborns’ blood analysis. The study design: A quasi experimental design was utilized in this study. Setting of the study: The study was conducted at the Dammam Maternity and Children Hospital, it is a Ministry of Health hospital with a higher delivery admission rate (25-3/day) according to the delivery room deputy nurse and hospital statistical records. Study sample: The study comprised a total of selective sample of 100 women during their second stage of labor and their newborns were selected according to certain criteria. Tools: Two tools developed and used by the researcher to collect the necessary data related to the study subjects as follows: First tool (Maternal tool): An Interview questionnaire sheet contained the following parts: Part one, demographic data such as (age, occupational and education level.), Part two: Obstetrical history such as (gravidity, parity, last menstruation period and gestational age). Second tool (Newborn tool): A newborn sheet contained the following parts: Part one: Early and late clamping record sheet which consists of date, time, mode of delivery and time of cord clamping (using a stopwatch). Part two: Complete new born blood count sheet to assess the level of C.B.C (Hb, RBCs, Hct and serum bilirubin and any complications or admission to the NICU) immediately and 24 hours after birth for both groups. Methods: The necessary approvals from the ethical committee in Dammam University and General medical research committee in Saudi Arabia were obtained to collect the necessary data. Based on the present study findings, it can be illustrated that the delaying of the newborn’s umbilical cord clamping at birth (1-3 minutes) have an important effect on newborns’ hematologic status. The delaying of the umbilical cord clamping 1-3 minutes after birth decreased the number of anemia cases. The study has shown that the hypothesis to be true and proved the effect of late cord clamping on the newborn’s blood analysis. Significant associations were observed between the time of cord clamping and the improvement of the hematological values of the newborns’ blood analysis. Recommendations: According to the findings of the present study it is recommended to delay cord clamping and it should be the standardized practice and be supported by the Ministry of Health and hospital administration.

Effect of Early and Late Clamping of the Umbilical Cord on the Newborns Blood Analysis

Background: At the time of birth, the infant is still attached to the mother via the umbilical cord, which is a part of the placenta. The infant is usually separated from the placenta by clamping the cord. Timing of umbilical cord clamping has been and still is a highly controversial issue worldwide, the controversy about the best time to clamp the cord. The main aim of the study is to identify the effect of early and late cord clamping on newborns’ blood analysis. Hypothesis: The researcher hypothesized that the delayed cord clamping (1-3 minutes) after birth will make a difference on newborns’ blood analysis. The study design: A quasi experimental design was utilized in this study. Setting of the study: The study was conducted at the Dammam Maternity and Children Hospital, it is a Ministry of Health hospital with a higher delivery admission rate (25-3/day) according to the delivery room deputy nurse and hospital statistical records. Study sample: The study comprised a total of selective sample of 100 women during their second stage of labor and their newborns were selected according to certain criteria. Tools: Two tools developed and used by the researcher to collect the necessary data related to the study subjects as follows: First tool (Maternal tool): An Interview questionnaire sheet contained the following parts: Part one, demographic data such as (age, occupational and education level.), Part two: Obstetrical history such as (gravidity, parity, last menstruation period and gestational age). Second tool (Newborn tool): A newborn sheet contained the following parts: Part one: Early and late clamping record sheet which consists of date, time, mode of delivery and time of cord clamping (using a stopwatch). Part two: Complete new born blood count sheet to assess the level of C.B.C (Hb, RBCs, Hct and serum bilirubin and any complications or admission to the NICU) immediately and 24 hours after birth for both groups. Methods: The necessary approvals from the ethical committee in Dammam University and General medical research committee in Saudi Arabia were obtained to collect the necessary data. Based on the present study findings, it can be illustrated that the delaying of the newborn’s umbilical cord clamping at birth (1-3 minutes) have an important effect on newborns’ hematologic status. The delaying of the umbilical cord clamping 1-3 minutes after birth decreased the number of anemia cases. The study has shown that the hypothesis to be true and proved the effect of late cord clamping on the newborn’s blood analysis. Significant associations were observed between the time of cord clamping and the improvement of the hematological values of the newborns’ blood analysis. Recommendations: According to the findings of the present study it is recommended to delay cord clamping and it should be the standardized practice and be supported by the Ministry of Health and hospital administration.

A Quasi-Experimental Study to Assess Consequences of Early Versus Delay Umbilical Cord Clamping on Maternal and Neonatal Outcomes in Beni-Suef city

A Quasi-Experimental Study to Assess Consequences of Early Versus Delay Umbilical Cord Clamping on Maternal and Neonatal Outcomes in Beni-Suef city

Fetal RBCs Potential in Obstetric Protocols to Minimize Fetomaternal Hemorrhage

Background: During pregnancy a small number of fetal RBCs (Red Blood Cells) enter maternal blood without risk, and incidence of significant feto-maternal hemorrhage (FMH) and isoimmunization depends on how much fetal blood enters maternal circulation; the use of flow cytometer (FCM) in FMH detection is considered the best laboratory technique. Aims: To evaluate role of FCM in FMH estimation to optimize delivery protocols and decrease isoimmunization. Subject and Method: 100 pregnant women at labor were included, equally classified into early cord clamping (ECC) and delayed cord clamping (DCC) groups, each including 25 women delivered vaginally and 25 with caesarian section; the control groups included 20 non-pregnant females, 20 at 3rd trimester and 20 neonates. Fetal RBCs were done on Becton Dickinson (B.D) FCM, and the reagents used were 5-Glutaraldehyde 0.5% Sigma cat. G5882, flouroscine isothiocyanite (FITC) anti-hemoglobin F (Hb-F) cat. 555748, anti-carbonic anhydrase, Triton-X100 solution and Alsever’s solution cat. HFH-11, 0.1% phosphate buffer saline/bovine serum albumin (PBS/BSA). Statistical Analysis: Mann Whitney’s U-test, Chi-squared, Fischer’s Exact tests, and SPSS for windows version 15.0. Results: There was a significant increase in the volume of the FMH in the ECC compared to DCC groups (p < 0.0001), also in the vaginal delivery comparing to caesarian section subgroups within the DCC group (p < 0.01), and in the ECC compared to DCC within caesarian section subgroup (p < 0.02). Conclusion: Fetal RBCs estimation by FCM is good; perinatal laboratory test should be done in routine investigations, as a guide for obstetric techniques that can alter FMH volume and decrease subsequent isoimmunization.

Clampage tardif du cordon ombilical chez les enfants prématurés nés avant 37 semaines d’aménorrhée : étude observationnelle prospective

Many international studies have demonstrated that delayed umbilical cord clamping reduces neonatal morbidity. However, in France, delayed umbilical cord clamping is still not performed in many neonatal units. The aims of this study were to evaluate the feasibility of developing a protocol of delayed umbilical cord clamping in the maternity ward of the Toulouse university hospital and to evaluate the impact of this new protocol on neonatal mortality.We conducted a prospective observational study including 123 preterm infants born before 37 weeks of gestation between June 2012 and June 2013 and hospitalized at birth. Delayed cord clamping was performed for at least 30s after birth; otherwise, it was evaluated as early cord clamping. We excluded twin-to-twin transfusion syndrome, congenital abnormalities, alloimmunization, and perinatal asphyxia. We analyzed the reasons why delayed umbilical cord clamping was not performed and then neonatal morbidity in our population.Delayed umbilical cord clamping was performed on 79 infants and 44 infants had early umbilical cord clamping. The two groups had similar baseline characteristics. Preterm infants in the delayed cord-clamping group had a higher level of hemoglobin during the first 24h of life (17.9g/dL versus 16.6g/dL, P=0.005), fewer of them required transfusion (14% versus 35%, P=0.03), and fewer presented late-onset sepsis (8% versus 26%, P=0.02) or bronchopulmonary dysplasia (9% versus 26%, P=0.03). There was no statistically significant increase of hyperbilirubinemia requiring phototherapy.Implanting a new protocol of delayed umbilical cord clamping in our maternity ward proved to be possible without difficulty. The advantages of delayed umbilical cord clamping were observed in this prospective study. Today, delayed cord clamping has become a common practice in our maternity unit.