Effect of Timing of Umbilical Cord Clamping in Elective Cesarean Section of Term Infants on Maternal and Neonatal Outcome in Benghazi Medical Center 2022-2023
Asian Journal of Pregnancy and Childbirth,
Page 278-287
Abstract
Background: The best time to clamp the umbilical cord has been disputed for decades, and definitions differ "Early" cord clamping (ECC) occurs before one minute after birth (about 15-30 seconds), whereas "delayed" cord clamping (DCC) occurs after one minute or when cord pulsations have stopped Doctors and midwives have traditionally defined ECC as malpractice, associated with danger and harm to both mother and newborn, and There is strong evidence that early cord clamping causes neonatal hypovolemia, anemia, and poor iron reserves.
Objectives: To determine the levels of newborn hemoglobin and serum ferritin at birth and three months after delivery in infants who had their umbilical cord clamped for 60 seconds. And to determine the levels of newborn hemoglobin and serum ferritin at birth and three months after birth in infants who had their umbilical cord clamped within 30 seconds.
Subjective and Methods: A randomized controlled trial was conducted in Benghazi Medical Center from June 2021 to March 2022 for 300 pregnant women who were admitted for elective cesarean section: 150 (the control group) received early cord clamping, and 150 (the study group) received delayed cord clamping.
Conclusion: Delay Cord Clamping provides considerable health benefits to term infants; it has been shown to lessen the risk of anemia in babies as young as three months old. Delay Cord Clamping (DCC) in term infants was feasible and safe, and there should be no hesitation in implementing this procedure routinely. Delay cord clamp is beneficial for the Apgar score of babies.
Keywords:
- Umbilical cord
- neonatal
- cord clamping
- maternal blood transfusion
How to Cite
ElGhazal, Z., Alasbaly, E., & Gadary, W. A. (2023). Effect of Timing of Umbilical Cord Clamping in Elective Cesarean Section of Term Infants on Maternal and Neonatal Outcome in Benghazi Medical Center 2022-2023. Asian Journal of Pregnancy and Childbirth, 6(1), 278-287. Retrieved from https://journalajpcb.com/index.php/AJPCB/article/view/30222
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Van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ. 2006;333: 954-8.
van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ (Clinical research ed.). 2006;333(7575):954–958. Available:https://doi.org/10.1136/bmj.39002.389236.BE
Sæther E, Gülpen FR, Jensen C, Myklebust TÅ, Eriksen BH. Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality- improvement cohort study. BMC pregnancy and childbirth. 2020;20(1):496. Available:https://doi.org/10.1186/s12884-020-03188-0
Fogarty M, Osborn DA, Askie L, Seidler AL, Hunter K, Lui K, Simes J, Tarnow-Mordi
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Yao AC, Hirvensalo M, Lind J. Placental transfusion-rate and uterine contraction. Lancet. 1968;291(7539):380-3. Available:https://doi.org/10.1016/S0140-6736(68)91352-4 [Accessed 3rd July 2008].
McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal neonatal outcomes. Cochrane Database of Systematic Reviews; 2008.
Welsh S, Elwell J, Manister NN, Gildersleeve RK. 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. 2020;65(1):109–118. Available:https://doi.org/10.1111/jmwh.13075
Blank DA, Badurdeen S, Omar F, Kamlin C, Jacobs SE, Thio M, Dawson JA, Kane SC, Dennis AT, Polglase GR, Hooper SB, Davis PG. Baby- directed umbilical cord clamping: A feasibility study. Resuscitation. 2018;131:1–7. Available:https://doi.org/10.1016/j.resuscitation.2018.07.020
Jaleel R, Deeba F, Khan A. Timing of umbilical cord clamping and neonatal haematological status. JPMA. The Journal of the Pakistan Medical Association. 2009;59(7):468–470.
van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Tropical Medicine & International Health: TM & IH. 2007;12(5):603–616. Available:https://doi.org/10.1111/j.1365-3156.2007.01835.x
Ceriani Cernadas JM, Carroli G, Pellegrini L, Otaño L, Ferreira M, Ricci C, Casas O, Giordano, D, Lardizábal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized, controlled trial. Pediatrics. 2006; 117(4):e779–e786. Available:https://doi.org/10.1542/peds.2005-1156
Chen X, Li X, Chang Y, Li W, Cui H. 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: Official Journal of the California Perinatal Association. 2018; 38(3):251–257. Available:https://doi.org/10.1038/s41372-017-0001-y
Hutton EK, Hassa ES. Late vs early clamping of the umbilical cord in full- term neonates: Systematic review and meta-analysis of controlled trials. JAMA. 2007;297(11):1241–1252. Available:https://doi.org/10.1001/jama.297.11.1241
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. The Cochrane database of systematic reviews, 2013;2013(7):CD004074. Available:https://doi.org/10.1002/14651858.CD004074.pub3
Qian Y, Ying X, Wang P, Lu Z, Hua Y. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Archives of gynecology and obstetrics. 2019;300(3):531–543. Available:https://doi.org/10.1007/s00404-019-05215-8
Nakagawa M, Ishida Y, Nagaoki Y, Ohta H, Shimabukuro R, Hirata M, Yamanaka M, Kusakawa I. Correlation between umbilical cord hemoglobin and rate of jaundice requiring phototherapy in healthy newborns. Pediatrics International: Official Journal of the Japan Pediatric Society. 2015;57(4):626–628. Available:https://doi.org/10.1111/ped.12583
Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anemic mothers: A randomized controlled trial. Indian pediatrics. 2002;39(2):130–135.
Das B, Sundaram V, Kumar P, Mordi WT, Dhaliwal LK, Das R. Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30-33 weeks Gestation. Indian journal of Pediatrics. 2018;85(3):172–178. Available:https://doi.org/10.1007/s12098- 017-2490-2
Andersson O, Hellstrom-Westas L, Domellof M. Elective caesarean: Does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study. BMJ Open. 2016;6(11):e012995.
Garton T, Hua Y, Xiang J, Xi G, Keep RF. Challenges for intraventricular hemorrhage research and emerging therapeutic targets. Expert Opin Ther Targets. 2017;21(12):1111– 1122.
Mercer JS, Erickson-Owens DA, Vohr BR, Tucker RJ, Parker AB, Oh W, Padbury JF. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: A randomized controlled trial. J Pediatr. 2016;168(50–55):e51.
Chiruvolu A, Tolia VN, Qin H, Stone GL, Rich D, Conant RJ, Inzer RW. Effect of delayed cord clamping on very preterm infants. American journal of obstetrics andgynecology. 2015;213(5): 676.e1–676.e6767. Available:https://doi.org/10.1016/j.ajog.2015.07.016
Dash MB, Murali R, Rajarajewari S. Effect of delayed cord clamping on Hemoglobin level among Newborns in Rajiv Gandi Government women & children Hospital, Paducherry. American Journal of Nursing Research. 2014;2(1): 7-11. DOI:10.12691/ajnr-2-1-2 [Accessed 3rd July 2008].
Musa O. Busarira, orcid, Entesar Alasbaly, Maryam Sulayman Mbark. Effect of Delayed versus Early Cord Clamping on Neonatal Outcomes and Iron Status at 4 Months, Open Journal of Obstetrics and Gynecology. 2019;9(2).
Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Líz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: A randomised controlled trial. Lancet. 2006;367(9527):1997–2004.
Laflamme EM. Maternal hemoglobin concentration and pregnancy outcomes: A study of effects of elevation in el alto, Bolivia. McGill Journal of Medicine. 2011;13(1):47-54. Available:https://www.ncbi.nlm.nih.gov/pmc/articles /PMC3296152/pdf/mjm- 1301-047.pdf [Accessed 3rd July 2008].
Wiberg N, Kallen K, Olofsson P. Delay umbilical cord clamping at birth has effect on arterial and venous blood gases and lactate concentration. British Journal of Obstetrics and Gynecology. 2008; 115(6):697-703
Van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ. 2006;333: 954-8.
van Rheenen PF, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ (Clinical research ed.). 2006;333(7575):954–958. Available:https://doi.org/10.1136/bmj.39002.389236.BE
Sæther E, Gülpen FR, Jensen C, Myklebust TÅ, Eriksen BH. Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality- improvement cohort study. BMC pregnancy and childbirth. 2020;20(1):496. Available:https://doi.org/10.1186/s12884-020-03188-0
Fogarty M, Osborn DA, Askie L, Seidler AL, Hunter K, Lui K, Simes J, Tarnow-Mordi
W. Delayed vs early umbilical cord clamping for preterm infants: A systematic review and meta-analysis. Am J Obstet Gynecol. 2018;218(1):1–18.
Yao AC, Hirvensalo M, Lind J. Placental transfusion-rate and uterine contraction. Lancet. 1968;291(7539):380-3. Available:https://doi.org/10.1016/S0140-6736(68)91352-4 [Accessed 3rd July 2008].
McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal neonatal outcomes. Cochrane Database of Systematic Reviews; 2008.
Welsh S, Elwell J, Manister NN, Gildersleeve RK. 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. 2020;65(1):109–118. Available:https://doi.org/10.1111/jmwh.13075
Blank DA, Badurdeen S, Omar F, Kamlin C, Jacobs SE, Thio M, Dawson JA, Kane SC, Dennis AT, Polglase GR, Hooper SB, Davis PG. Baby- directed umbilical cord clamping: A feasibility study. Resuscitation. 2018;131:1–7. Available:https://doi.org/10.1016/j.resuscitation.2018.07.020
Jaleel R, Deeba F, Khan A. Timing of umbilical cord clamping and neonatal haematological status. JPMA. The Journal of the Pakistan Medical Association. 2009;59(7):468–470.
van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Tropical Medicine & International Health: TM & IH. 2007;12(5):603–616. Available:https://doi.org/10.1111/j.1365-3156.2007.01835.x
Ceriani Cernadas JM, Carroli G, Pellegrini L, Otaño L, Ferreira M, Ricci C, Casas O, Giordano, D, Lardizábal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized, controlled trial. Pediatrics. 2006; 117(4):e779–e786. Available:https://doi.org/10.1542/peds.2005-1156
Chen X, Li X, Chang Y, Li W, Cui H. 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: Official Journal of the California Perinatal Association. 2018; 38(3):251–257. Available:https://doi.org/10.1038/s41372-017-0001-y
Hutton EK, Hassa ES. Late vs early clamping of the umbilical cord in full- term neonates: Systematic review and meta-analysis of controlled trials. JAMA. 2007;297(11):1241–1252. Available:https://doi.org/10.1001/jama.297.11.1241
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. The Cochrane database of systematic reviews, 2013;2013(7):CD004074. Available:https://doi.org/10.1002/14651858.CD004074.pub3
Qian Y, Ying X, Wang P, Lu Z, Hua Y. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Archives of gynecology and obstetrics. 2019;300(3):531–543. Available:https://doi.org/10.1007/s00404-019-05215-8
Nakagawa M, Ishida Y, Nagaoki Y, Ohta H, Shimabukuro R, Hirata M, Yamanaka M, Kusakawa I. Correlation between umbilical cord hemoglobin and rate of jaundice requiring phototherapy in healthy newborns. Pediatrics International: Official Journal of the Japan Pediatric Society. 2015;57(4):626–628. Available:https://doi.org/10.1111/ped.12583
Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anemic mothers: A randomized controlled trial. Indian pediatrics. 2002;39(2):130–135.
Das B, Sundaram V, Kumar P, Mordi WT, Dhaliwal LK, Das R. Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30-33 weeks Gestation. Indian journal of Pediatrics. 2018;85(3):172–178. Available:https://doi.org/10.1007/s12098- 017-2490-2
Andersson O, Hellstrom-Westas L, Domellof M. Elective caesarean: Does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study. BMJ Open. 2016;6(11):e012995.
Garton T, Hua Y, Xiang J, Xi G, Keep RF. Challenges for intraventricular hemorrhage research and emerging therapeutic targets. Expert Opin Ther Targets. 2017;21(12):1111– 1122.
Mercer JS, Erickson-Owens DA, Vohr BR, Tucker RJ, Parker AB, Oh W, Padbury JF. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: A randomized controlled trial. J Pediatr. 2016;168(50–55):e51.
Chiruvolu A, Tolia VN, Qin H, Stone GL, Rich D, Conant RJ, Inzer RW. Effect of delayed cord clamping on very preterm infants. American journal of obstetrics andgynecology. 2015;213(5): 676.e1–676.e6767. Available:https://doi.org/10.1016/j.ajog.2015.07.016
Dash MB, Murali R, Rajarajewari S. Effect of delayed cord clamping on Hemoglobin level among Newborns in Rajiv Gandi Government women & children Hospital, Paducherry. American Journal of Nursing Research. 2014;2(1): 7-11. DOI:10.12691/ajnr-2-1-2 [Accessed 3rd July 2008].
Musa O. Busarira, orcid, Entesar Alasbaly, Maryam Sulayman Mbark. Effect of Delayed versus Early Cord Clamping on Neonatal Outcomes and Iron Status at 4 Months, Open Journal of Obstetrics and Gynecology. 2019;9(2).
Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Líz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: A randomised controlled trial. Lancet. 2006;367(9527):1997–2004.
Laflamme EM. Maternal hemoglobin concentration and pregnancy outcomes: A study of effects of elevation in el alto, Bolivia. McGill Journal of Medicine. 2011;13(1):47-54. Available:https://www.ncbi.nlm.nih.gov/pmc/articles /PMC3296152/pdf/mjm- 1301-047.pdf [Accessed 3rd July 2008].
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