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

Kuo, Kelly; Gokhale, Priyanka; Hackney, David; Ruangkit, Chayatat; Bhola, Monika; March, Melissa

doi:10.1080/14767058.2017.1280018

Cited by 12 publications

(13 citation statements)

References 12 publications

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“…This finding signifies the risk of bleeding complications in higher-order gestations and this risk might be accentuated by DCC. However, a previous study that monitored maternal outcomes following the initiation of the DCC protocol did not find any increased maternal EBL or PPH associated with DCC [25], consistent with the results of a recent systematic review and meta-analysis of DCC in preterm infants [2]. Since our study was not primarily targeted to assess the effect of DCC on maternal complications, it is possible that the incidence of PPH occurred by chance.…”

Section: Discussionsupporting

confidence: 65%

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

et al. 2018

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Background: Delayed cord clamping (DCC) improves placental transfusion and increases blood volume in preterm infants when compared with immediate cord clamping (ICC). However, evidence to support DCC in multiple-birth preterm infants is still lacking. Objective: To compare the outcomes of ICC versus DCC in preterm infants of multiple births. Study Design: Women with a multiple pregnancy, including twins and triplets with a gestational age of 28–36 weeks, were randomized to receive ICC (23 women and 50 infants) or DCC for 30–60 s (24 and 51 infants). The infants’ hematocrit on admission, superior vena cava (SVC) flow measured within 24 h, and hematocrit at 8 weeks of age were compared. The use of uterotonic agents during delivery was not controlled in this study. Result: All infants were delivered by cesarean section (CS) except for 2 sets of twins, 1 in each group. Maternal and infant baseline characteristics in both groups were comparable. There were no significant differences between the groups in admission hematocrit, SVC flow measured within 24 h, hematocrit at 8 weeks of age, or any other neonatal outcomes. The incidence of maternal postpartum hemorrhage (PPH) was higher in the DCC group (4.3% in ICC vs. 25% in DCC, p = 0.04). Conclusion: DCC for 30–60 s did not improve placental transfusion or increase systemic blood flow in multiple-birth infants born preterm, mostly by CS, when compared with ICC. The finding of a higher PPH rate in the DCC group raises concerns about the maternal safety of this procedure in this patient population.

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Section: Discussionsupporting

confidence: 65%

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

et al. 2018

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“…Despite limited data, no difference has been found in the rate of postpartum hemorrhage, estimated blood loss, or a prolonged third stage of labor with DCC as compared with ICC. 10,11 Our data on potential adverse maternal outcomes also did not demonstrate a signal for harm with DCC. As DCC becomes a more widely utilized intervention, future studies should be powered to assess maternal outcomes adequately.…”

Section: Commentmentioning

confidence: 51%

“…Our results are consistent with other studies that have assessed implementation of a DCC protocol and found a similar compliance rate of ~70% following initiation of their DCC protocols. 8–10 Our results on adherence to the protocol suggest that there remains an opportunity for further provider education and quality improvement initiatives regarding compliance with the indications and contraindications to DCC as outlined in the protocol.…”

Section: Commentmentioning

confidence: 88%

Delayed Umbilical Cord Clamping at <32 Weeks' Gestation: Implementation and Outcomes

et al. 2017

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Objectives This study aims to evaluate the implementation of a delayed umbilical cord clamping (DCC) protocol for neonates <32 weeks. Secondarily, to evaluate the impact of DCC on maternal outcomes and on the ability to obtain umbilical cord blood gases. Study Design Retrospective cohort study from November 2014 to March 2016 of patients delivered by 316/7 weeks. In 2014, an institutional protocol for DCC at <32 weeks was implemented. We assessed adherence to the protocol and compared adverse maternal outcomes (utilizing a hemorrhage composite). We evaluated the impact of DCC on the ability to obtain adequate umbilical cord blood gas specimens. Results Of the 185 patients included in the study, 90 underwent DCC, and 72% of potentially eligible patients appropriately received DCC. There was no significant difference in the maternal hemorrhage composite outcome between DCC and immediate cord clamping (23.3 vs. 36.8%, adjusted odds ratio = 0.64, 95% confidence interval = 0.33, 1.26). There was also no significant difference in the ability to obtain a single or paired umbilical cord blood gas result. Conclusion Implementation of a DCC protocol for preterm neonates is feasible and was successful. We did not find an increase in maternal risk or a decrease in the ability to obtain umbilical cord blood gases following DCC.

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“…When we assessed the previous PPH definition of EBL > 1,000 mL for cesarean delivery, our rates are consistent with prior data on PPH in similar studies. 4,5,13 After stratification by mode of delivery, we found an increased risk of PPH in cesarean deliveries postprotocol. This difference may be attributable to a 60-second delay in repair of the bleeding hysterotomy.…”

Section: Discussionmentioning

confidence: 88%

“…Our overall results on PPH are consistent with prior data that have not found an increased risk of PPH with DCC. 1,4,5,13 Using the current definition of PPH of EBL !1,000 mL from the American College of Obstetricians and Gynecologists, we found a high overall rate of PPH in our cesarean delivery subgroup. This is likely because 15% of patients had an EBL equal to 1,000 mL in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

Implementation and Outcomes of Universal Delayed Umbilical Cord Clamping at Term

et al. 2018

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

Abstract: An institutional DCC protocol for deliveries <34 weeks was not associated with an identifiable increase in adverse maternal outcomes.

Cited by 12 publications

References 12 publications

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

Delayed Umbilical Cord Clamping at <32 Weeks' Gestation: Implementation and Outcomes

Implementation and Outcomes of Universal Delayed Umbilical Cord Clamping at Term

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