Rhoades Janine S, Bierut Tatiana, Conner Shayna N, Tuuli Methodius G, Vesoulis Zachary A, Macones George A, Cahill Alison G
Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
Am J Perinatol. 2017 Sep;34(11):1048-1053. doi: 10.1055/s-0037-1603591. Epub 2017 May 25.
This study aims to evaluate the implementation of a delayed umbilical cord clamping (DCC) protocol for neonates <32 weeks. Secondarily, to evaluate the impact of DCC on maternal outcomes and on the ability to obtain umbilical cord blood gases.
Retrospective cohort study from November 2014 to March 2016 of patients delivered by 31 weeks. In 2014, an institutional protocol for DCC at <32 weeks was implemented. We assessed adherence to the protocol and compared adverse maternal outcomes (utilizing a hemorrhage composite). We evaluated the impact of DCC on the ability to obtain adequate umbilical cord blood gas specimens.
Of the 185 patients included in the study, 90 underwent DCC, and 72% of potentially eligible patients appropriately received DCC. There was no significant difference in the maternal hemorrhage composite outcome between DCC and immediate cord clamping (23.3 vs. 36.8%, adjusted odds ratio = 0.64, 95% confidence interval = 0.33, 1.26). There was also no significant difference in the ability to obtain a single or paired umbilical cord blood gas result.
Implementation of a DCC protocol for preterm neonates is feasible and was successful. We did not find an increase in maternal risk or a decrease in the ability to obtain umbilical cord blood gases following DCC.
本研究旨在评估针对孕周小于32周的新生儿实施延迟脐带结扎（DCC）方案的情况。其次，评估延迟脐带结扎对产妇结局以及获取脐血气能力的影响。
对2014年11月至2016年3月孕周达31周分娩的患者进行回顾性队列研究。2014年实施了一项针对孕周小于32周的延迟脐带结扎机构方案。我们评估了对该方案的依从性，并比较了不良产妇结局（采用出血综合指标）。我们评估了延迟脐带结扎对获取足够脐血气标本能力的影响。
纳入研究的185例患者中，90例接受了延迟脐带结扎，72%的潜在符合条件患者正确接受了延迟脐带结扎。延迟脐带结扎组与立即脐带结扎组在产妇出血综合结局方面无显著差异（23.3%对36.8%，调整优势比=0.64，95%置信区间=0.33，1.26）。在获取单个或配对脐血气结果的能力方面也无显著差异。
为早产儿实施延迟脐带结扎方案是可行且成功的。我们未发现延迟脐带结扎后产妇风险增加或获取脐血气能力下降。
