Leslie M S, Greene J, Schulkin J, Jelin A C
School of Nursing, George Washington University, Washington, DC, USA.
Marxe School of Public and International Affairs, Baruch College, CUNY, NY, USA.
J Neonatal Perinatal Med. 2018;11(1):51-60. doi: 10.3233/NPM-181729.
Delayed umbilical cord clamping is associated with significant benefits to preterm and term newborns and is recommended for all infants by the World Health Organization and the American College of Obstetricians and Gynecologists (ACOG). Little is known about the cord management practices of U.S. obstetricians.
The objective of this study was to describe current cord clamping practices by U.S. obstetricians and investigate factors associated with delayed cord clamping.
A cross-sectional survey was sent to 500 members of the American College of Obstetricians and Gynecologists. Umbilical cord practices were assessed, and factors related to delaying cord clamping were examined using Chi-square tests and multivariate logistic regression models.
The overall response rate was 37% with 74% of those opening the email responding. Sixty-seven percent of respondents reported DCC by one minute or more after vaginal births at term. After preterm and near-term vaginal births, 73% and 79% said they waited at least 30 seconds before clamping. The factor most consistently and strongly related to delaying cord clamping in both bivariate and multivariate analyses was having the belief that the timing of clamping was important. Additional analysis revealed that believing the timing was important was positively associated with the physician's institution having a written policy on the cord clamping.
In this study, a majority of respondents reported delaying cord clamping and indicated that employing strategies to implement the full uptake of this practice could be valuable. Findings suggest that institutional policies may influence attitudes on cord clamping.
延迟脐带结扎对早产和足月新生儿有显著益处，世界卫生组织和美国妇产科医师学会（ACOG）建议对所有婴儿采用该方法。关于美国产科医生的脐带处理做法知之甚少。
本研究的目的是描述美国产科医生当前的脐带结扎做法，并调查与延迟脐带结扎相关的因素。
向美国妇产科医师学会的500名成员发送了一份横断面调查问卷。评估了脐带处理做法，并使用卡方检验和多变量逻辑回归模型检查了与延迟脐带结扎相关的因素。
总体回复率为37%，打开邮件回复的人中有74%做出了回应。67%的受访者报告称，在足月阴道分娩后一分钟或更长时间才进行延迟脐带结扎。在早产和接近足月的阴道分娩后，分别有73%和79%的人表示他们在结扎前等待了至少30秒。在双变量和多变量分析中，与延迟脐带结扎最一致且最密切相关的因素是认为结扎时间很重要。进一步分析表明，认为时间很重要与医生所在机构有关于脐带结扎的书面政策呈正相关。
在本研究中，大多数受访者报告延迟脐带结扎，并表示采用策略以全面推广这种做法可能很有价值。研究结果表明，机构政策可能会影响对脐带结扎的态度。
