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足月儿脐带结扎的相关因素。

Factors associated with umbilical cord clamping in term newborns.

作者信息

Strada Juliana Karine Rodrigues, Vieira Leticia Becker, Gouveia Helga Geremias, Betti Thais, Wegner Wiliam, Pedron Cecília Drebes

机构信息

Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil.

出版信息

Rev Esc Enferm USP. 2022 Mar 28;56:e20210423. doi: 10.1590/1980-220X-REEUSP-2021-0423. eCollection 2022.

DOI:10.1590/1980-220X-REEUSP-2021-0423
PMID:35348571
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10081613/
Abstract

OBJECTIVE

To identify factors associated with umbilical cord clamping in term newborns and to compare the recording of clamping time in the medical record with what was observed.

METHOD

Cross-sectional study, with 300 mothers-infants, in a university hospital. Clamping time and medical records were observed, and a structured questionnaire was applied to postpartum women for sociodemographic variables. Bivariate analysis, multivariate Poisson Regression model, and Kappa concordance test were performed.

RESULTS

The percentage of late/optimal clamping observed was 53.7%. The associated factors were skin-to-skin contact in the delivery room (PR = 0.76; 0.61-0.95; p = 0.014), position of the newborn below the vaginal canal (PR = 2.6; CI95%: 1.66-4.07; p < 0.001), position of the newborn at the vaginal level (PR = 2.03; CI95%: 1.5-2.75; p < 0.001), and need for newborn resuscitation in the delivery room (PR = 1.42; CI95%; 1.16-1.73; p = 0.001). Kappa concordance level of the professionals, records compared to the observation was: nurse 0.47, obstetrician 0.59, and pediatrician 0.86.

CONCLUSION

the identification of associated factors and the comparison between recording and observing the clamping time can help in the planning and implementation of improvements for adherence to good practices at birth.

摘要

目的

确定足月儿脐带结扎的相关因素,并比较病历中记录的结扎时间与实际观察情况。

方法

在一家大学医院对300对母婴进行横断面研究。观察结扎时间和病历情况,并对产后妇女应用结构化问卷以获取社会人口学变量信息。进行双变量分析、多变量泊松回归模型分析和kappa一致性检验。

结果

观察到的延迟/最佳结扎百分比为53.7%。相关因素包括产房内的皮肤接触(PR = 0.76;0.61 - 0.95;p = 0.014)、新生儿位于阴道管下方的位置(PR = 2.6;95%CI:1.66 - 4.07;p < 0.001)、新生儿位于阴道水平的位置(PR = 2.03;95%CI:1.5 - 2.75;p < 0.001)以及产房内新生儿复苏的需求(PR = 1.42;95%CI:1.16 - 1.73;p = 0.001)。专业人员记录与观察的kappa一致性水平为:护士0.47,产科医生0.59,儿科医生0.86。

结论

确定相关因素以及比较记录的和观察到的结扎时间有助于规划和实施改进措施,以促进出生时良好做法的遵循。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8bf/10081613/eca816dbbba7/1980-220X-reeusp-56-e20210423-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8bf/10081613/eca816dbbba7/1980-220X-reeusp-56-e20210423-gf1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a8bf/10081613/eca816dbbba7/1980-220X-reeusp-56-e20210423-gf1.jpg

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本文引用的文献

1
Italian Recommendations for Placental Transfusion Strategies.意大利胎盘输血策略建议
Front Pediatr. 2018 Dec 3;6:372. doi: 10.3389/fped.2018.00372. eCollection 2018.
2
First do no harm - interventions during labor and maternal satisfaction: a descriptive cross-sectional study.首先不造成伤害 - 分娩期间的干预措施和产妇满意度:一项描述性的横断面研究。
BMC Pregnancy Childbirth. 2018 Oct 24;18(1):415. doi: 10.1186/s12884-018-2054-0.
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Acceptability of Bedside Resuscitation With Intact Umbilical Cord to Clinicians and Patients' Families in the United States.
美国临床医生和患者家属对保留脐带进行床边复苏的接受度。
Front Pediatr. 2018 Apr 26;6:100. doi: 10.3389/fped.2018.00100. eCollection 2018.
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Umbilical cord clamping practices of U.S. obstetricians.美国产科医生的脐带结扎方法
J Neonatal Perinatal Med. 2018;11(1):51-60. doi: 10.3233/NPM-181729.
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Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal.尼泊尔三级医院中与脐带结扎时机相关的因素。
BMC Res Notes. 2018 Jan 31;11(1):89. doi: 10.1186/s13104-018-3198-8.
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How to Engage Your Team to Implement Delayed Cord Clamping.如何促使团队实施延迟脐带结扎
Nurs Womens Health. 2017 Dec;21(6):489-498. doi: 10.1016/j.nwh.2017.10.003.
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Fifteen-minute consultation: stabilisation of the high-risk newborn infant beside the mother.15分钟会诊:在母亲身旁对高危新生儿进行稳定治疗。
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Current umbilical cord clamping practices and attitudes of obstetricians and midwives toward delayed cord clamping in Saudi Arabia.沙特阿拉伯目前的脐带 clamping 做法以及产科医生和助产士对延迟脐带 clamping 的态度。 (注:“clamping”常见释义为“夹紧;钳制” ,这里结合医学语境可能有更专业准确的表述,比如“脐带结扎”等,但按照要求未做调整)
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Timing of umbilical cord clamping of term infants.足月儿脐带结扎的时机。
Arch Argent Pediatr. 2017 Apr 1;115(2):188-194. doi: 10.5546/aap.2017.eng.188.
10
Placental Transfusion Strategies in Italy: A Nationwide Survey of Tertiary-Care Delivery Wards.意大利的胎盘输血策略:一项对三级护理分娩病房的全国性调查。
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