Effect of Delayed Cord Clamp on Maternal and Neonatal Outcomes

Authors

  • Reda M. Nabil Aboushady Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Giza Governorate 12613, Egypt
  • Amel Dawod Kamel Gouda Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Giza Governorate 12613, Egypt ; College of Nursing, King Saud bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center; Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia
  • Nesren S.M. Bahnsawy Department of Pediatric Nursing, Faculty of Nursing, Cairo University, Giza Governorate 12613, Egypt
  • Hend Wageh Abozed Department of Pediatric Nursing, Faculty of Nursing, Mansoura University, Dakahlia Governorate 35516, Egypt
  • Sahar Mansour Ibrahim Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Giza Governorate 12613, Egypt

DOI:

https://doi.org/10.31674/mjn.2023.v15i02.006

Abstract

Background: Third-stage labor with a Delayed Cord Clamp (DCC), is still being discussed and there are currently no definite regulations or instructions for doctors to abide by, and little knowledge exists on the possible consequences for both the mother and the baby. Aim:  Evaluate the effect of delayed cord clamp on maternal and neonatal outcomes. Methods: The posttest-only quasi-experimental research design was carried out. This study was conducted at the labor and delivery unit at Mansoura University Hospital (MUH). A convenient sample of 200 laboring mothers. The first 100 mothers were the study group. The second 100 mothers were the control group. Four tools were utilized to gather data. structured interview questionnaire the maternal assessment, the maternal satisfaction questionnaire and the neonatal assessment tool. Results: More than three-quarters of the study group compared to less than two-thirds of the control group had a duration third stage of labor within 5-10 minutes with a highly statistically significant difference at (p=0.001). Three cases of postpartum hemorrhage occur in the DCC group as compared to 5% in the control group. There was a noticeable contrast in the health of newborn babies between the two groups after 24 hours, particularly in regard to hemoglobin, hematocrit, ferritin, and total bilirubin levels. Conclusion: Delayed cord clamp is a safe and simple procedure during the third stage of labour and is associated with better maternal and neonatal outcomes with no adverse effects. Recommendations: DCC should be performed routinely on all laboring mothers throughout the third stage of labor in all delivery units.

Keywords:

Delayed Cord Clamp, Maternal Outcomes, Neonatal Outcomes

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References

Abbas, T. R., Elboghdady, A. A., & Mohammed, M. E. A. S. (2019). Early versus delayed umbilical cord clamping in preterm births. The Egyptian Journal of Hospital Medicine, 77(1), 4700-4704.

Abiyoga, A., & Meihartati, T. (2020). Stimulation of dairy milk on active management kala iii on time of placenta disposal. Malaysian Journal of Medical Research (MJMR), 4(4), 43-47. http://doi:10.31674/mjmr.2020.v04i04.010

Alzaree, F., Elbohoty, A., & Abdellatif, M. (2018). Early versus delayed umbilical cord clamping on physiologic anemia of the term newborn infant. Open access Macedonian Journal of Medical Sciences, 6(8), 1399–1404. https://doi.org/10.3889/oamjms.2018.286

American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice (2020). Delayed umbilical cord clamping after birth: acog committee opinion, number 814. Obstetrics and Gynecology, 136(6), e100–e106. https://doi.org/10.1097/AOG.0000000000004167

Apgar, V. (1953). A proposal for a new method of evaluation of the newborn infant. Anesthesia & Analgesia, 32(4), 260-267. https://doi.org/10.1213/ane.0b013e31829bdc5c

Ashish, K. C., Rana, N., Målqvist, M., Ranneberg, L. J., Subedi, K., & Andersson, O. (2017). Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: A randomized clinical trial. JAMA Pediatrics, 171(3), 264-270. https://doi.org/10.1001/jamapediatrics.2016.3971.

Chaudhary, P., Priyadarshi, M., Singh, P., Chaurasia, S., Chaturvedi, J., & Basu, S. (2023). Effects of Delayed Cord Clamping at Different Time Intervals in Late Preterm and Term Neonates: A Randomized Controlled Trial. European Journal of Pediatrics, 1-11. https://doi.org/10.1007/s00431-023-05053-6

Chen, X., Li, X., Chang, Y., Li, W., & Cui, H. (2018). Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: a randomized controlled trial. Journal of Perinatology, 38(3), 251-257. https://doi.org/10.1038/s41372017-0001-y

Chidre, Y. V., & Chirumamilla, V. (2015). Impact of early versus delayed umbilical cord clamping on post-partum blood loss: a randomized controlled trial. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 4(4), 1103-1109. http://dx.doi.org/10.18203/2320-1770.ijrcog20150436.

De Angelis, C., Saccone, G., Sorichetti, E., Alagna, M., Zizolfi, B., Gragnano, E., ... & Sardo, A. D. S. (2022). Effect of delayed versus immediate umbilical cord clamping in vaginal delivery at term: a randomized clinical trial. International Journal of Gynecology & Obstetrics, 159(3), 898-902. https://doi.org/10.4236/ojog.2021.1111141

De Paco, C., Herrera, J., Garcia, C., Corbalán, S., Arteaga, A., Pertegal, M., ... & Delgado, J. L. (2016). Effects of delayed cord clamping on the third stage of labour, maternal haematological parameters, and acid–base status in fetuses at term. European Journal of Obstetrics & Gynecology and Reproductive Biology, 207, 153-156. https://doi.org/10.1016/j.ejogrb.2016.10.031.

Elgzar, W. T. I., Ibrahim, H. A. F., & Elkhateeb, H. H. (2017). Effects of deferred versus early umbilical cord clamping on maternal and neonatal outcomes. American Journal of Nursing, 5(4), 115-128. https://doi.org/10.1080/14767058.2019.1602603

Heba, A. I., Galal, A. E., Amal, A. O., &Aziza I. M. (2018). Effect of early versus late cord clamping of term infants on maternal and neonatal outcomes. Egyptian Journal of Health Care, 9(3): 1-13. https://doi.org/10.21608/EJHC.2018.12956.

Hooper, S. B., Binder-Heschl, C., Polglase, G. R., Gill, A. W., Kluckow, M., Wallace, E. M., ... & Te Pas, A. B. (2016). The timing of umbilical cord clamping at birth: physiological considerations. Maternal Health, Neonatology and Perinatology, 2, 1-9. https://doi.org/10.1186/s40748-016-0032-y

Ibrahim, N. O., Sukkarieh, H. H., Bustami, R. T., Alshammari, E. A., Alasmari, L. Y., & Al-Kadri, H. M. (2017). Current umbilical cord clamping practices and attitudes of obstetricians and midwives toward delayed cord clamping in saudi arabia. Annals of Saudi Medicine, 37(3), 216-224. https://doi.org/10.5144/0256-4947.2017.216

Katheria, A. C., Brown, M. K., Faksh, A., Hassen, K. O., Rich, W., Lazarus, D., ... & Finer, N. N. (2017). Delayed cord clamping in newborns born at term at risk for resuscitation: A feasibility randomized clinical trial. The Journal of Pediatrics, 187, 313-317. https://doi.org/10.1016/j.jpeds.2017.04.033

Kresch, M. J. (2017). Management of The Third Stage of Labor: How Delayed Umbilical Cord Clamping Can Affect Neonatal Outcome. American Journal of Perinatology, 34(14), 1375-1381. https://doi.org/10.1055/s-0037-1603733

Lara-Cantón, I., Badurdeen, S., Dekker, J., Davis, P., Roberts, C., Te Pas, A., & Vento, M. (2022). Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping. Pediatric Research, 1-6. https://doi.org/10.1038/s41390-021-01805-y.

Lu, J., Yue, G., Wang, Q., Zhou, X., & Ju, R. (2022). A review on the development of placental transfusion in term and preterm infants. Frontiers in Pediatrics, 10, 890988. https://doi.org/10.3389/fped.2022.890988.

Madhavanprabhakaran, G. K., Wittmann, A. L., Vaidyanathan, G., Aldughaishi, T., & Thomas, D. S. (2018). Knowledge and Practice of Umbilical Cord Clamping among Maternity Care Providers. Journal of Midwifery & Reproductive Health, 6(3). https://doi.org/10.22038/JMRH.2018.23553.1252

McAdams, R. M., Backes, C. H., & Hutchon, D. J. (2015). Steps for implementing delayed cord clamping in a hospital setting. Maternal Health, Neonatology and Perinatology, 1, 1-8. https://doi.org/10.1186/s40748-015-0011-8

McDonald, S. J., Middleton, P., Dowswell, T., & Morris, P. S. (2014). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Evidence‐Based Child Health: A Cochrane Review Journal, 9(2), 303-397. https://doi.org/10.1002/ebch.1971

Mercer, J. S., Erickson-Owens, D. A., Collins, J., Barcelos, M. O., Parker, A. B., & Padbury, J. F. (2017). Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. Journal of Perinatology, 37(3), 260-264. https://doi.org/10.1038/jp.2016.222 .

Mohammad, K., Tailakh, S., Fram, K., & Creedy, D. (2021). Effects of early umbilical cord clamping versus delayed clamping on maternal and neonatal outcomes: a jordanian study. The Journal of Maternal-Fetal & Neonatal Medicine, 34(2), 231-237. https://doi.org/10.1080/14767058.2019.1602603 .

National Institute for Health and Care Excellence [NICE], (2017). Intrapartum Care for Healthy Women and Babies: CG190UK: NICE. 2017. https://www.nice.org.uk/guidance/cg190 . Accessed on 28th November 2022.

Ofojebe, C. J., Eleje, G. U., Ikechebelu, J. I., Okpala, B. C., Ofojebe, B. A., Ugwu, E. O., ... & Ejikeme, T. B. (2021). A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns. European Journal of Obstetrics & Gynecology and Reproductive Biology, 262, 99-104. https://doi.org/10.1016/j.ejogrb.2021.04.038.

Orenga-Orenga, B. J., Gregori-Roig, P., Real-Fernández, A., Donat-Colomer, F., & Sánchez-Thevenet, P. (2022). Umbilical cord clamping time and maternal satisfaction. Midwifery, 115, 103487. https://doi.org/10.1016/j.midw.2022.103487

Qian, Y., Ying, X., Wang, P., Lu, Z., & Hua, Y. (2019). Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Archives of Gynecology and Obstetrics, 300, 531-543. https://doi.org/10.1007/s00404-019-05215-8.

Rabe, H., Gyte, G. M., Díaz‐Rossello, J. L., & Duley, L. (2019). Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database of Systematic Reviews, (9). https://doi.org/10.1002/14651858.

Rana, N., Ranneberg, L. J., Målqvist, M., Kc, A., & Andersson, O. (2020). Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks. Acta Paediatrica, 109(1), 71-77. https://doi.org/10.1111/apa.14913

Ricci, S.S. (2017). Essentials of maternity, newborn, and mothers’s health nursing. 4th ed. New York (NY): Wolters Kluwer.

Royal College of Obstetricians and Gynecologists, (2015). Clamping of the Umbilical Cord and Placental Transfusion. https://www.rcog.org.uk/en/guidelines-research-services/guidelines/sip14/. Access on 15th December, 2022.

Sim, J., Saunders, B., Waterfield, J., & Kingstone, T. (2018). Can sample size in qualitative research be determined a priori?. International Journal of Social Research Methodology, 21(5), 619-634. https://doi.org/10.1080/13645579.2018.1454643.

Thomas, L. (2022). Quasi-Experimental Design: Definition, Types & Examples. Scribbr. https://www.scribbr.com/methodology/quasi-experimental-design/. Accessed on 16th December, 2022.

Welsh, S., Elwell, J., Manister, N. N., & Gildersleeve, R. K. (2020). Implementing delayed umbilical cord clamping in cesarean birth using a novel method: a pilot study of feasibility and safety. Journal of Midwifery & Women's Health, 65(1), 109-118. https://doi.org/10.1111/jmwh.13075 .

Winkler, A., Isacson, M., Gustafsson, A., Svedenkrans, J., & Andersson, O. (2022). Cord clamping beyond 3 minutes: Neonatal short‐term outcomes and maternal postpartum hemorrhage. Birth, 49(4), 783-791. https://doi.org/10.1111/birt.12645 .

World Health Organization (WHO) (2023). Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Guideline: apps. who.int/iris/bitstream/10665/148793/1/9789241508209eng.pdf

World Health Organization (WHO) (2018). Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants. Geneva, Switzerland. https://www.who.int/tools/elena/interventions/cord-clamping. Access on 16th December, 2022.

Published

15-10-2023

How to Cite

Nabil Aboushady, R. M. ., Gouda, A. D. K. ., Bahnsawy, N. S. ., Abozed, H. W. ., & Ibrahim, S. M. . (2023). Effect of Delayed Cord Clamp on Maternal and Neonatal Outcomes . The Malaysian Journal of Nursing (MJN), 15(2), 48-58. https://doi.org/10.31674/mjn.2023.v15i02.006

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