Kuo Kelly, Gokhale Priyanka, Hackney David N, Ruangkit Chayatat, Bhola Monika, March Melissa
a Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division , Oregon Health & Science University , Portland , OR , USA.
b Department of Obstetrics and Gynecology , Northwestern University , Chicago , IL , USA.
J Matern Fetal Neonatal Med. 2018 Jan;31(2):197-201. doi: 10.1080/14767058.2017.1280018. Epub 2017 Feb 14.
The objective of this study is to evaluate maternal outcomes before and after implementation of an institutional delayed cord clamping (DCC) protocol.
We performed a secondary analysis of a retrospective cohort study of deliveries occurring at <34 weeks at a tertiary care center in 2013-2014. About 139 women who underwent early cord clamping were compared with 130 women delivered after DCC protocol implementation. Maternal estimated blood loss (EBL) was the primary outcome of interest. Operative times, post-Cesarean decrease in hemoglobin (Hgb), and rates of post-partum hemorrhage and transfusion were also examined in bivariate and multivariable analyses.
About 75% of post-guideline deliveries had actual DCC. In regression analyses, only Cesarean delivery and multifetal gestation increased EBL. No trends were identified in EBL over time. In post-hoc analysis, the study had over 80% power to detect a difference in post-partum hemorrhage rates of 20%.
An institutional DCC protocol for deliveries <34 weeks was not associated with an identifiable increase in adverse maternal outcomes.
本研究的目的是评估机构延迟脐带结扎（DCC）方案实施前后的孕产妇结局。
我们对2013 - 2014年在一家三级护理中心发生的孕周小于34周的分娩进行回顾性队列研究的二次分析。将约139例接受早期脐带结扎的妇女与130例在DCC方案实施后分娩的妇女进行比较。孕产妇估计失血量（EBL）是主要关注的结局。在双变量和多变量分析中还检查了手术时间、剖宫产术后血红蛋白（Hgb）下降情况以及产后出血和输血率。
指南发布后约75%的分娩实际采用了DCC。在回归分析中，只有剖宫产和多胎妊娠会增加EBL。未发现EBL随时间的变化趋势。在事后分析中，该研究有超过80%的把握度检测到产后出血率20%的差异。
针对孕周小于34周的分娩的机构DCC方案与可识别的孕产妇不良结局增加无关。
