Umbilical cord management strategies at cesarean section.
cesarean section
delayed cord clamping
neonatal hematocrit
placental transfusion strategy
umbilical cord milking
Journal
The journal of obstetrics and gynaecology research
ISSN: 1447-0756
Titre abrégé: J Obstet Gynaecol Res
Pays: Australia
ID NLM: 9612761
Informations de publication
Date de publication:
22 Sep 2020
22 Sep 2020
Historique:
received:
26
02
2020
revised:
02
09
2020
accepted:
07
09
2020
entrez:
22
9
2020
pubmed:
23
9
2020
medline:
23
9
2020
Statut:
aheadofprint
Résumé
To evaluate the effect of different strategies to improve placental transfusion in cesarean section (CS). Retrospective analysis of all singleton term pregnancies that underwent CS over 6 months. Delayed umbilical cord clamping (dUCC) was defined as one done at least 60 s after birth. Umbilical cord milking (UCM) was an option when waiting 60 s was deemed unsafe. The two strategies were compared against early (<60 s) umbilical cord clamping (eUCC) without milking. Neonatal hematocrit (Hct) at 48 h was the main outcome variable. Of the 223 CS in the cohort, 100 were performed in labor and 123 were elective. dUCC was performed in 137, eUCC without milking in 53 and UCM in 33 cases. Neonatal Hct was higher in CS carried out in labor versus in elective CS (59.76% ± 6.17 vs 56.91% ± 5.95, P = 0.001). At multivariate analysis, CS performed in labor (coefficient [coeff.] 3.44, confidence interval [CI] 1.75-5.13, P < 0.001), UCM (coeff. 3.88, CI 1.61-6.14, P = 0.001) and birth weight (coeff. -0.003, CI -0.005 to -0.001, P = 0.001) were the only variables independently associated with neonatal Hct. In elective CS, UCM led to higher neonatal Hct (61.5% ± 5.5) compared to eUCC without milking (55.1% ± 5.5) and dUCC (56.4% ± 5.7, P = 0.001), while in CS performed in labor there were no significant differences among the placental transfusion strategies. In term CS, neonatal Hct is significantly higher when the CS is performed in labor or with UCM. In elective CS, UCM could be a valid option to favor placental transfusion.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2020 Japan Society of Obstetrics and Gynecology.
Références
Yao AC, Moinian M, Lind J. Distribution of blood between infant and placental afterbirth. Lancet 1969; 2: 871-873.
Dewey KG, Chaparro CM. Session 4: Mineral metabolism and body composition iron status of breast-fed infants. Proc Nutr Soc 2007; 66: 412-422.
Ghirardello S, Di Tommaso M, Fiocchi S et al. Italian recommendations for placental transfusion strategies. Front Pediatr 2018; 6: 37.
Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: A randomized clinical trial. JAMA Pediatr 2015; 169: 631-638.
Rana N, Kc A, Målqvist M, Subedi K, Andersson O. Effect of delayed cord clamping of term babies on neurodevelopment at 12 months: A randomized controlled trial. Neonatology 2019; 115: 36-42.
World Health Organization. Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes. Geneva: The Organization, 2014.
Hosono S, Mugishima H, Fujita H et al. Umbilical cordmilking reduces the need for red cell transfusions and improves neonatal adaptation ininfants born at less than 29 weeks' gestation: A randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93: F14-F19.
Alan S, Arsan S, Okulu E et al. Effects of umbilical cord milking on the need for packed red blood cell transfusions and early neonatal hemodynamic adaptation in preterm infants born≤1500 g: A prospective, randomized, controlled trial. J Pediatr Hematol Oncol 2014; 36: e493-e498.
Katheria AC, Leone TA, Woelkers D, Garey DM, Rich W, Finer NN. The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates. J Pediatr 2014; 164: 1045-1050.
March MI, Hacker MR, Parson AW, Modest AM, de Veciana M. The effects of umbilical cord milking inextremely preterm infants: A randomized controlled trial. J Perinatol 2013; 33: 763-767.
Rabe H, Jewison A, Alvarez RF et al. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: A randomized controlled trial. Obstet Gynecol 2011; 117 (Pt 1): 205-211.
Katheria AC. Umbilical cord milking: A review. Front Pediatr 2018; 6: 335.
ACOG. Committee opinion no. 684: Delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129: e5-e10.
Zhou YB, Li HT, Zhu LP, Liu JM. Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: A systematic review and meta-analysis. Placenta 2014; 35: 1-8.
Ghirardello S, Cinotti A, Di Tommaso M et al. Raccomandazioni italiane per la gestione del clampaggio ed il milking del cordone ombelicale nel neonato a termine e pretermine. SIN, SIMP, FNCOe AOGOI, 2017.
Ministero della Salute. Taglio cesareo: Una scelta appropriata e consapevole. Italian Guideline, 2012.
Katheria AC, Lakshminrusimha S, Rabe H, McAdams R, Mercer JS. Placental transfusion: A review. J Perinatol 2017; 37: 105-111.
Al-Wassia H, Shah PS. Efficacy and safety of umbilical cord milking at birth: A systematic review and meta-analysis. JAMA Pediatr 2015; 169: 18-25.
Erickson-Owens DA, Mercer JS, Oh W. Umbilical cord milking in term infants delivered by cesarean section: A randomized controlled trial. J Perinatol 2012; 32: 580-584.
Cavallin F, Galeazzo B, Loretelli V et al. Delayed cord clamping versus early cord clamping in elective cesarean section: A randomized controlled trial. Neonatology 2019; 116: 252-259.
Purisch SE, Ananth CV, Arditi B et al. Effect of delayed vs immediate umbilical cord clamping on maternal blood loss in term cesarean delivery: A randomized clinical trial. JAMA 2019; 322: 1869-1876.
Ersdal HL, Linde J, Mduma E, Auestad B, Perlman J. Neonatal outcome following cord clamping after onset of spontaneous respiration. Pediatrics 2014; 134: 265-272.
Kleinberg F, Dong L, Phibbs RH. Cesarean section prevents placenta-to-infant transfusion despite delayed cord clamping. Am J Obstet Gynecol 1975; 121: 66-70.
Andersson O, Hellström-Westas L, Domellöf 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: e012995.
Hutton EK, Hassan ES. Late vs. early clamping of the umbilical cord in full-term neonates systematic review and meta-analysis of controlled trials. JAMA 2007; 297: 1241-1252.
McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; (7): CD004074.
Blank DA, Polglase GR, Kluckow M et al. Haemodynamic effects of umbilical cord milking in premature sheep during the neonatal transition. Arch Dis Child Fetal Neonatal Ed 2018; 103: F539-F546.
Katheria AC, Reister F, Essers J et al. Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. JAMA 2019; 322: 1877-1886.