Implementation of Delayed Cord Clamping for 3 Min During Term Cesarean Sections Does Not Influence Maternal Blood Loss

Abstract

Background: To assess maternal safety outcomes after a local protocol adjustment to change the interval of cord clamping to 3 min after term cesarean section.Design, Setting, and Patients: A retrospective cohort study in a tertiary referral hospital (Erasmus MC, Rotterdam). We included pregnant women who gave birth at term after cesarean section. A cohort (Nov 2016–Oct 2017) prior to the protocol implementation was compared to a cohort after its implementation (Nov 2017–Nov 2018). The study population covered 789 women (n = 376 pre-cohort; n = 413 post-cohort).Interventions: Implementation of a local protocol changing the interval of cord clamping to 3 min in all term births.Main outcome measures: Primary outcomes were the estimated maternal blood loss and the occurrence of postpartum hemorrhage (blood loss >1,000 ml). Secondary outcomes included both maternal as well as neonatal outcomes.Results: Estimated maternal blood loss was not significantly different between the pre-cohort and post-cohort (400 mL [300–600] vs. 400 mL [300–600], p = 0.52). The incidence of postpartum hemorrhage (26 [6.9%] vs. 35 (8.5%), OR 1.24, 95% CI 0.73–2.11) and maternal blood transfusion (9 [2%] vs. 13 (3%), OR 1.33, 95% CI 0.56–3.14) were not different. Hemoglobin change was significantly higher in the post-cohort (−0.8 mmol/L [−1.3 to −0.5] vs. −0.9 mmol/L [−1.4 to −0.6], p = 0.01). In the post-cohort, neonatal hematocrit levels were higher (51 vs. 55%, p = 0.004) and need for phototherapy was increased (OR 1.95, 95% CI 0.99–3.84).Conclusion: Implementation of delayed cord clamping for 3 min in term cesarean sections was not associated with increased maternal bleeding complications.

Placental cord drainage vs delayed cord clamping at elective caesarean section: A randomised controlled trial

“…It is associated with increased neonatal haemoglobin concentrations at 24–48 h postnatal, improved infant iron stores at 3–6 months 7 and improved scores in neurodevelopmental questionnaires at 3–4 years old 18,19 . While it is associated with an increased need for phototherapy for neonatal jaundice, 7,20 and difficulties in obtaining 8 and interpreting umbilical cord blood gases, 9,10 these issues have not been major concerns in well‐resourced settings with capacity to provide phototherapy and observation.…”

“…Obstetricians have expressed concerns regarding the perceived risk of greater maternal blood loss associated with DCC, due to a delay in closure of the vascular uterine incision. Studies have demonstrated conflicting evidence, with findings varying from reduced blood loss, 12,13 to no significant difference, 10 to an increased rate of PPH 8 . However, both small randomised controlled trials which have reported on this issue demonstrated no significant difference in maternal blood loss at caesarean with DCC 9,11 …”

“…DCC has become increasingly prevalent due to the associated increase in neonatal haemoglobin and iron stores, 7 but has not yet been universally embraced at caesarean due to conflicting evidence on the effect on maternal blood loss. [8][9][10][11][12][13] Our primary goal was to determine whether PCD at elective caesarean accelerates placental delivery. Our secondary outcomes focused on whether this translates to a reduction in blood loss.…”

“…DCC has become increasingly prevalent due to the associated increase in neonatal haemoglobin and iron stores, 7 but has not yet been universally embraced at caesarean due to conflicting evidence on the effect on maternal blood loss 8–13 …”