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

Abstract

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.

Reference Values for Umbilical Artery Lactate by Mode of Delivery and Gestational Age: A Retrospective Observational Study

“…We demonstrated that lactate values vary across different modes of delivery with an incremental increase from eCS via unplanned CS and spontaneous vaginal to VID where lactate values were the highest. This is comparable to recent findings from smaller studies [10,13]. We propose 2 mechanisms for these findings: first, delayed cord clamping contributes to increased lactate by prolonging the time until blood sampling [13,14], which may have contributed to higher values in vaginal deliveries.…”

“…This is comparable to recent findings from smaller studies [10,13]. We propose 2 mechanisms for these findings: first, delayed cord clamping contributes to increased lactate by prolonging the time until blood sampling [13,14], which may have contributed to higher values in vaginal deliveries. Second, various peripartal risk factors (e.g., uterine rupture, placental abruption, chorioamnionitis, and pre-eclampsia) may have contributed to higher lactate values.…”

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

“…This was recently also reported in a prospective study evaluating the effect of delayed cord clamping on cord blood analysis in uncomplicated births. Delayed cord clamping at cesarean section resulted in a mixed respiratory and metabolic acidosis with increased pCO 2 and lactate, in combination with a reduction in base excess ( 30 – 32 ). In our data, we confirmed the moderate decrease in base excess, but pCO 2 values were not different.…”

Clampeamento tardio do cordão umbilical: interferência no desenvolvimento da anemia ferropriva neonatal e outros benefícios / Delayed umbilical cord clamping: interference in the development of neonatal iron deficiency anemia and other benefits

“…Por esse fator, ao clampear o cordão umbilical mais tardiamente, a passagem de sangue da placenta para o feto continuará contribuindo para uma melhor perfusão tecidual e trocas gasosas, além do aumento no ganho de peso. 6 Vários fatores podem desencadear a anemia ferropriva no período neonatal e na infância, porém, a combinação entre as necessidades elevadas de ferro devido ao crescimento e a dieta pobre do mineral são consideradas os principais. 2,13,16 Alguns estudos também evidenciam benefícios ao recém-nascido a termo quando colocado a 10 cm abaixo do nível do útero durante os três primeiros minutos de vida, aumentando em 32% em média no volume de sangue corporal.…”

“…Além disso, notaram-se uma redução na incidência de hemorragia intraventricular, enterocolite necrotizante, hipoglicemia, doenças respiratórias, sepse e menores taxas de transfusão sanguínea. 3,4,6,18,20…”