Medical Student Frank H. Netter School of Medicine, North Haven, CT, USA.
Department of Obstetrics and Gynecology, Trinity Health of New England, Hartford, CT, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(23):4607-4611. doi: 10.1080/14767058.2020.1857357. Epub 2020 Dec 7.
Given concerns amongst physicians and other maternity providers for increased maternal blood loss with delayed cord clamping, our objective was to determine the impact of routine delayed clamping with term cesarean section on maternal blood loss metrics.
A retrospective cohort study evaluated the impact of delayed cord clamping in term cesareans at our tertiary care center following protocol implementation. The pre-protocol group (PRE) ranged 1 October 2015 to 31 March 2016. The post-protocol (POST) group ranged 1 October 2017 to 31 March 2018. The primary outcome was maternal estimated blood loss (EBL) during cesarean section. Secondary outcomes included maternal transfusion, hemorrhage (EBL > 1,000 mL), and changes in hemoglobin (Hgb) and hematocrit (HCT). Neonatal outcomes were APGAR scores at 1 and 5 min.
733 subjects were included, (PRE = 416, POST = 317). Overall 44.7% reported prior cesarean section. Preop differences included only platelets k/µL (222 vs. 211, = .015), Hgb g/dL (11.7 vs. 11.9, = .002) and HCT% (36.2 vs. 35.2, = .027), with Hgb and HCT differences in opposite clinical directions. EBL actually decreased after the delayed cord clamping protocol ( = .04). The median [interquartile range] was the same (700 [600-800]), but the PRE group had higher proportions of EBL 800-1,000 (16% vs. 11%) and EBL > 1,000 (4.3% vs 3.7%) comprising this statistical difference. There was no difference in maternal transfusion (2.2%), hemorrhage (11.1%), or change in Hgb (Δ = -1.6 g/dL) or HCT (Δ = -4.6%), (all > .05). APGAR scores were slightly lower in the POST group at 1 min (8 [8-9] vs. 9 [8-9], = .035) but similar by 5 min (9 [9-9], = .38).
Concerns for increased maternal blood loss during cesarean delivery after implementing a routine delayed cord clamping protocol were not supported. While EBL was lower with delayed cord clamping, all differences between groups appear to lack clinical significance. This offers reassuring evidence there is no negative impact on maternal hematologic characteristics including blood loss from the delayed cord clamping protocol.
鉴于医生和其他产科医务人员对延迟夹脐带会增加产妇失血的担忧，我们的目的是确定常规延迟夹脐带对足月剖宫产产妇失血指标的影响。
本回顾性队列研究评估了我们的三级保健中心在实施方案后，足月剖宫产时延迟夹脐带对产妇的影响。预方案组（PRE）为 2015 年 10 月 1 日至 2016 年 3 月 31 日。后方案组（POST）为 2017 年 10 月 1 日至 2018 年 3 月 31 日。主要结局是剖宫产术中产妇估计失血量（EBL）。次要结局包括产妇输血、出血（EBL＞1000ml）以及血红蛋白（Hgb）和红细胞压积（HCT）的变化。新生儿结局为 1 分钟和 5 分钟时的 APGAR 评分。
共纳入 733 例患者，（PRE=416，POST=317）。总体上，44.7%的患者有过剖宫产史。术前差异仅血小板 k/µL（222 比 211，=0.015）、Hgb g/dL（11.7 比 11.9，=0.002）和 HCT%（36.2 比 35.2，=0.027），Hgb 和 HCT 差异呈相反的临床方向。延迟夹脐带方案实施后，EBL 实际上减少（=0.04）。中位数[四分位数范围]相同（700[600-800]），但 PRE 组 EBL 800-1000（16%比 11%）和 EBL＞1000（4.3%比 3.7%）的比例更高，构成了这一统计学差异。产妇输血（2.2%）、出血（11.1%）或 Hgb（Δ=-1.6g/dL）或 HCT（Δ=-4.6%）变化无差异（均>0.05）。POST 组在 1 分钟时 APGAR 评分稍低（8[8-9]比 9[8-9]，=0.035），但在 5 分钟时相似（9[9-9]，=0.38）。
实施常规延迟夹脐带方案后，对剖宫产术中产妇失血增加的担忧并未得到证实。虽然延迟夹脐带后 EBL 较低，但组间所有差异似乎都缺乏临床意义。这提供了令人放心的证据，表明延迟夹脐带方案不会对产妇的血液学特征产生负面影响，包括失血。
