Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and the Department of Pediatrics, UC Davis Children's Hospital, UC Davis Health, Sacramento, California.
Obstet Gynecol. 2022 Jan 1;139(1):121-137. doi: 10.1097/AOG.0000000000004625.
This review summarizes high-quality evidence supporting delayed umbilical cord clamping to promote placental transfusion to preterm and term neonates. In preterm neonates, delayed cord clamping may decrease mortality and the need for blood transfusions. Although robust data are lacking to guide cord management strategies in many clinical scenarios, emerging literature is reviewed on numerous topics including delivery mode, twin gestations, maternal comorbidities (eg, gestational diabetes, red blood cell alloimmunization, human immunodeficiency virus [HIV] infection, and severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and neonatal complications (eg, fetal growth restriction, congenital heart disease, and the depressed neonate). Umbilical cord milking is an alternate method of rapid placental transfusion, but has been associated with severe intraventricular hemorrhage in extremely preterm neonates. Data on long-term outcomes are discussed, as well as potential contraindications to delayed cord clamping. Overall, delayed cord clamping offers potential benefits to the estimated 140 million neonates born globally every year, emphasizing the importance of this simple and no-cost strategy.
这篇综述总结了高质量的证据，支持延迟脐带夹闭以促进胎盘向早产儿和足月儿输血。在早产儿中，延迟脐带夹闭可能降低死亡率和输血需求。尽管缺乏大量数据来指导许多临床情况下的脐带管理策略，但对许多主题的新出现文献进行了综述，包括分娩方式、双胎妊娠、母体合并症（如妊娠期糖尿病、红细胞同种免疫、人类免疫缺陷病毒[HIV]感染和严重急性呼吸综合征冠状病毒 2[SARS-CoV-2]感染）和新生儿并发症（如胎儿生长受限、先天性心脏病和抑郁新生儿）。脐带挤奶是一种快速胎盘输血的替代方法，但与极早产儿严重的脑室出血有关。还讨论了长期结果的数据，以及延迟脐带夹闭的潜在禁忌证。总的来说，延迟脐带夹闭为全球每年估计出生的 1.4 亿新生儿带来了潜在的益处，强调了这一简单且无成本的策略的重要性。
