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

Abstract

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 < 0.001) were observed regarding neonatal hemoglobin, hematocrit, and red blood cells between the two groups. The mean total bilirubin level was significantly higher (P < 0.05) in the deferred cord clamping group than early cord clamping group. 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 75 th 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.

Effects of early umbilical cord clamping versus delayed clamping on maternal and neonatal outcomes: a Jordanian study

“…Despite increasing evidence, delayed cord clamping is still not practiced in most Arab countries [3,13,21,22]. Relatively few studies have investigated the effects of early versus delayed cord clamping on maternal and neonatal outcomes in Arab countries, with the exception of studies conducted in Egypt and Saudi Arabia [3,9,13]. In the current study, the authors found that delayed cord clamping had a positive impact on newborns and mothers compared to those receiving early cord clamping.…”

“…Recent recommendations by WHO [4] included delayed cord clamping to manage the third stage of labor and promote various maternal and neonatal benefits. Despite increasing evidence, delayed cord clamping is still not practiced in most Arab countries [3,13,21,22]. Relatively few studies have investigated the effects of early versus delayed cord clamping on maternal and neonatal outcomes in Arab countries, with the exception of studies conducted in Egypt and Saudi Arabia [3,9,13].…”

“…The newborn venous sample was taken by a pediatric resident and sent to the laboratory in the Jordan University Hospital. Based on the published data, bilirubin levels in the current study were divided into four diagnostic categories: normal-low risk below 40th percentile ( [13,20].…”

“…Delayed cord clamping allows more time for placental transfusion which in turn protects the newborn from anemia without increased risk of jaundice [11,[13][14][15]. Furthermore, infants gain protected time for adjustment because circulation from the placenta continues for a few minutes after birth and the newborn continues to obtain oxygen through the umbilical cord [11,15].…”

“…Furthermore, infants gain protected time for adjustment because circulation from the placenta continues for a few minutes after birth and the newborn continues to obtain oxygen through the umbilical cord [11,15]. Delayed cord clamping also has positive effects on mothers such as decreasing the occurrence of red blood cell alloimmunization without any negative consequences such as PPH, manual removal of the placenta, and prolonging the third stage of labor [13]. Disadvantages of delayed cord clamping include increased risk of polycythemia and transient tachypnea of the newborn infant which may occur due to delayed absorption of lung fluid caused by an increase in blood volume [11].…”