Delayed cord clamping does not affect umbilical cord blood gas analysis

Tang, Jie; Fullarton, R.; Samson, Sheri-Lee; Chen, Yu

doi:10.1007/s00404-019-05048-5

Cited by 10 publications

(10 citation statements)

References 19 publications

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“…1 Prior data are mixed on the effect of delayed cord clamping on cord arterial pH, with 2 studies showing a small but statistically significant decrease in pH 19,20 and 4 studies showing no difference. 10,18,21,22 Delayed cord clamping was, in this study, associated with a statistically lower umbilical cord arterial pH and base excess compared with immediate cord clamping. However, the absolute difference between groups was small (0.02 for pH and −1.4 for base excess) and the median pH and base excess were still in the normal range for both groups.…”

Section: Discussionmentioning

confidence: 51%

Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery

Purisch

Ananth

Arditi

et al. 2019

JAMA

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recommends a delay in umbilical cord clamping in term neonates for at least 30 to 60 seconds after birth. Most literature supporting this practice is from low-risk vaginal deliveries. There are no published data specific to cesarean delivery. OBJECTIVE To compare maternal blood loss with immediate cord clamping vs delayed cord clamping in scheduled cesarean deliveries at term (Ն37 weeks). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial performed at 2 hospitals within a tertiary academic medical center in New York City from October 2017 to February 2018 (follow-up completed March 15, 2018). A total of 113 women undergoing scheduled cesarean delivery of term singleton gestations were included. INTERVENTIONS In the immediate cord clamping group (n = 56), cord clamping was within 15 seconds after birth. In the delayed cord clamping group (n = 57), cord clamping was at 60 seconds after birth. MAIN OUTCOMES AND MEASURES The primary outcome was change in maternal hemoglobin level from preoperative to postoperative day 1, which was used as a proxy for maternal blood loss. Secondary outcomes included neonatal hemoglobin level at 24 to 72 hours of life. RESULTS All of the 113 women who were randomized (mean [SD] age, 32.6 [5.2] years) completed the trial. The mean preoperative hemoglobin level was 12.0 g/dL in the delayed and 11.6 g/dL in the immediate cord clamping group. The mean postoperative day 1 hemoglobin level was 10.1 g/dL in the delayed group and 9.8 g/dL in the immediate group. There was no significant difference in the primary outcome, with a mean hemoglobin change of −1.90 g/dL (95% CI, −2.14 to −1.66) and −1.78 g/dL (95% CI, −2.03 to −1.54) in the delayed and immediate cord clamping groups, respectively (mean difference, 0.12 g/dL [95% CI, −0.22 to 0.46]; P = .49). Of 19 prespecified secondary outcomes analyzed, 15 showed no significant difference. The mean neonatal hemoglobin level, available for 90 neonates (79.6%), was significantly higher with delayed (18.1 g/dL [95% CI, 17.4 to 18.8]) compared with immediate (16.4 g/dL [95% CI, 15.9 to 17.0]) cord clamping (mean difference, 1.67 g/dL [95% CI, 0.75 to 2.59]; P < .001). There was 1 unplanned hysterectomy in each group. CONCLUSIONS AND RELEVANCE Among women undergoing scheduled cesarean delivery of term singleton pregnancies, delayed umbilical cord clamping, compared with immediate cord clamping, resulted in no significant difference in the change in maternal hemoglobin level at postoperative day 1.

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Section: Discussionmentioning

confidence: 51%

Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery

Purisch

Ananth

Arditi

et al. 2019

JAMA

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“…Interestingly, studies evaluating acid–base status through serial samples drawn at different time points from the same patient found a significant reduction of pH during DCC. Conversely, no significant change in arterial pH was observed when CBG analyses were drawn from two distinct cohorts of infants undergoing immediate or delayed cord clamping …”

Section: Discussionmentioning

confidence: 93%

“…Whether the different methodology, the lower number of patients, or the temporal variability of cord sampling may explain the discrepancies among study results requires further investigation …”

Section: Discussionmentioning

confidence: 99%

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The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean‐delivered term newborns without fetal distress: a prospective observational study

Giovannini

Crippa

Denaro

et al. 2019

BJOG

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Objective To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress.Design Prospective observational study. Setting University hospital.Sample CBG from 97 VDs and 124 CDs without fetal distress.Methods Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs.Main outcome measures Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO 2 ), partial pressure of carbon dioxide (pCO 2 ), pH, and postpartum haemorrhage.Results Arterial cord blood pH, bicarbonate (HCO À 3 , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO À 3 = 23.3 versus 24.3; P = 0.004; BE = À5.1 versus À2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO À 3 = 26.2 versus 27.2; P < 0.001; BE = À1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO 2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [À0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit.Conclusions After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs.Tweetable abstract By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively. The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean-delivered term newborns without fetal distress: a prospective observational study. BJOG 2020;127:405-413.

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“…Indeed, delayed cord clamping is the recommended procedure due to the reported benefits for term and preterm infants (16)(17)(18). Studies on the effects of delayed cord clamping on cord gas analysis have reported conflicting and non-definitive results (19,20). This study provides a basis for performing research in a larger population to be used as a useful tool to missing samples in high-risk deliveries and in infants subjected to birth asphyxia (21).…”

Section: Differences In Ua and In Uv Parameters Between Aga Term And mentioning

confidence: 98%

Differences between umbilical blood gas in term and preterm newborns

Tataranno¹,

Bernardo²,

Trevisanuto³

et al. 2019

Electron. physician

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Introduction: Cord blood gas analysis reflects placental respiratory and metabolic function and is commonly used to assess fetal status at birth. Our aim was to identify the differences in blood gas parameters between the umbilical artery (UA) and umbilical vein (UV) in term and preterm infants. Methods: This was a prospective pilot study. Umbilical cord artery and UV samples were consecutively collected from 225 term and 57 preterm infants at the University Hospital of Padua and at the neonatal unit of Ruesch Hospital in Naples, Italy. Blood gas-analysis and glucose measurement were performed in all samples. Term infants were divided into adequate for gestational age (AGA) and small for gestational age (SGA) according to birth weight percentile. Data were analyzed using Pearson Product-Moment Correlation, independent-samples t-test, and paired-samples t-test. A p-value <0.05 was considered statistically significant. Results: The median gestational age of preterm and term newborns were 34 weeks (±2) and 39 weeks (±1) respectively. The pH, pO2, were lower and pCO2, HCO3 − and base excess (BE) were higher in the UA compared with the UV, in both AGA and SGA term infants. In preterm infants, no statistically significant differences were found between the UA and UV regarding pH, while the pO2 was lower and pCO2 was higher in the UA than UV (respectively: 22.5 vs. 32.4 and 53.1 vs. 42.8; p<0.0001). In the UA, pO2, BE and potassium (K +) were lower (respectively: 22.5 vs. 25.1;-2.5 vs.-3.7; 4.8 vs. 5.8; p<0.001) while sodium (Na +) and calcium (Ca ++) were higher in preterm than term newborns (respectively: 135.7 vs. 133.6; p<0.001; 1.4 vs. 1.3; p<0.001). Glycaemia was lower in the UA than in the UV in all newborns (respectively: 66 vs. 77 in AGA term newborns; 63 vs. 71 in SGA term newborns; 68 vs. 76 in preterm newborns; p<0.0001) and was related to venous glycaemia measured in the first hour of life (n= 282, r =0.60; p<0.001). Conclusions: Significant differences in blood gas parameters between the UA and UV in term and preterm newborns suggest the importance of the placental barrier and the need for accurate cord blood gas analysis interpretation at birth. UA and UV samples at birth are required to assess with higher accuracy the metabolic status of the newborn in utero. Further studies are needed to evaluate if cord glycemic values could be a noninvasive tool for prediction of glycaemia during the first hour of life.

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Delayed cord clamping does not affect umbilical cord blood gas analysis

Cited by 10 publications

References 19 publications

Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery

Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery

The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean‐delivered term newborns without fetal distress: a prospective observational study

Differences between umbilical blood gas in term and preterm newborns

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