School of Nursing, University of Connecticut, Storrs, Connecticut.
School of Medicine, University of Connecticut, Farmington, Connecticut.
J Midwifery Womens Health. 2020 Jan;65(1):109-118. doi: 10.1111/jmwh.13075. Epub 2020 Jan 16.
Although delayed cord clamping (DCC) is regarded as the standard of care for all vigorous newborns, those born via cesarean birth are less likely to be afforded this option, especially for longer than 30 to 60 seconds. This pilot study was undertaken to determine whether removal of the placenta before cord clamping to allow for DCC of at least 3 minutes during term, uncomplicated cesarean birth is feasible and without apparent safety issues in order to support a large prospective study on the benefits of this method.
Women having a term, uncomplicated cesarean birth who consented to the study were enrolled. Safety was assessed by comparing estimated maternal blood loss, newborn Apgar scores, temperatures, transcutaneous bilirubin levels, need for phototherapy, and neonatal intensive care unit admissions with a matched historical control group of women whose newborns had immediate cord clamping. Feasibility was measured by evaluating staff and maternal comfort with the intervention and by the ability to complete the protocol steps.
Seventeen women consented to participate. The protocol was successfully completed in 94% of births. There were no differences in maternal and neonatal safety outcome measures between groups. There was high comfort level with the protocol among staff, and there was universal maternal satisfaction.
This method of DCC in cesarean birth appears feasible and safe in this small pilot study and was associated with high maternal satisfaction and clinician comfort. Major organizations such as the American College of Nurse-Midwives and the World Health Organization have called for DCC of up to 3 to 5 minutes in all births, and this simple method has the potential to reach that goal in cesarean birth with minimal apparent risk. A large randomized controlled trial is warranted to determine the neonatal and maternal benefits and safety of this technique compared with a 30-to-60-second delay.
尽管延迟脐带夹闭（DCC）被视为所有活力新生儿的标准护理，但那些通过剖宫产分娩的新生儿不太可能选择这种方法，尤其是延迟时间超过 30 至 60 秒。本研究旨在确定在剖宫产分娩中，是否可以在胎盘移除前进行 DCC，以允许在足月、无并发症的剖宫产中至少进行 3 分钟的 DCC，并且这种方法是否没有明显的安全问题，从而支持一项关于该方法益处的大型前瞻性研究。
对同意参与研究的足月、无并发症的剖宫产产妇进行研究。通过比较两组产妇的估计失血量、新生儿 Apgar 评分、体温、经皮胆红素水平、是否需要光疗以及新生儿重症监护病房入院率，评估安全性。通过评估工作人员和产妇对干预措施的舒适度以及完成方案步骤的能力来衡量可行性。
共有 17 名产妇同意参与研究。94%的分娩成功完成了方案。两组产妇和新生儿的安全性指标均无差异。工作人员对方案的舒适度水平很高，产妇满意度普遍较高。
在这项小型试点研究中，剖宫产中 DCC 的这种方法似乎是可行且安全的，并且与产妇的高满意度和临床医生的舒适度相关。美国护理助产士学院和世界卫生组织等主要组织呼吁在所有分娩中进行 3 至 5 分钟的 DCC，这种简单的方法有可能在剖宫产中以最小的明显风险达到这一目标。需要进行大规模的随机对照试验来确定与 30-60 秒延迟相比，该技术对新生儿和产妇的益处和安全性。
