Bouadi Naila, Beltempo Marc, Éthier Guillaume, Boucoiran Isabelle, McDonald Sarah D, Villeneuve Andréanne
Faculty of Medicine, Laval University, Quebec, QC.
Department of Pediatrics, McGill University Health Centre, Montreal, QC; Division of Neonatology, McGill University Health Centre, Montreal, QC.
J Obstet Gynaecol Can. 2024 Nov;46(11):102659. doi: 10.1016/j.jogc.2024.102659. Epub 2024 Sep 12.
Guidelines recommending deferred cord clamping (DCC), delaying cord clamping for at least 30 seconds post-birth, have shown significant benefits in preterm singleton births. However, evidence supporting DCC in twins is scarce due to limited trial data, leading to practice variations. This study aims to assess current reported DCC practices for twin pregnancies in tertiary hospitals across Canada.
A web-based survey was distributed to neonatologists and obstetrician investigators associated with the Canadian Neonatal and Preterm Birth Networks operating maternity and neonatal units.
The site response rate was 93% (28/30 sites), with 83% (25/30) for neonatologists and 56% (17/30) for obstetricians. The majority had a local protocol for twin pregnancies (obstetricians 13/17, neonatologists 21/25). While all centres practised DCC in dichorionic-diamniotic twins, a difference was noted for monochorionic-diamniotic twins, with 56% of neonatologists and 65% of obstetricians performing DCC. During cesarean delivery, most obstetricians (76.5%) placed the firstborn on the mother's thighs. Neonatologists varied in their practices, with 32% placing the baby on the mother's abdomen, 32% on the mother's thighs, and 28% holding the baby at the height of the perineum. Divergent opinions were observed regarding contraindications, including risks of postpartum hemorrhage and velamentous cord insertion.
DCC is reported to be practised in most twin deliveries among Canadian Neonatal and Preterm Birth Network centres. However, there are wide variations in practice, especially concerning the characteristics of the twins in which DCC is performed. Future research should investigate optimal cord clamping management in twins to standardize practices and maximize benefits.
推荐延迟脐带结扎（DCC）的指南建议，即出生后至少延迟30秒结扎脐带，已显示出对单胎早产有显著益处。然而，由于试验数据有限，支持双胎延迟脐带结扎的证据很少，导致实践存在差异。本研究旨在评估加拿大各三级医院目前报告的双胎妊娠延迟脐带结扎的实践情况。
向与运营产科和新生儿病房的加拿大新生儿和早产网络相关的新生儿科医生和产科研究人员进行了一项基于网络的调查。
机构回复率为93%（28/30个机构），新生儿科医生的回复率为83%（25/30），产科医生的回复率为56%（17/30）。大多数机构有双胎妊娠的本地方案（产科医生13/17，新生儿科医生21/25）。虽然所有中心在双绒毛膜双羊膜囊双胎中都实行延迟脐带结扎，但在单绒毛膜双羊膜囊双胎中存在差异，56%的新生儿科医生和65%的产科医生进行延迟脐带结扎。剖宫产时，大多数产科医生（76.5%）将第一个出生的婴儿放在母亲大腿上。新生儿科医生的做法各不相同，32%将婴儿放在母亲腹部，32%放在母亲大腿上，28%在会阴高度托住婴儿。在包括产后出血风险和帆状脐带附着等禁忌症方面观察到不同意见。
据报告，在加拿大新生儿和早产网络中心的大多数双胎分娩中都实行延迟脐带结扎。然而，实践中存在很大差异，特别是在进行延迟脐带结扎的双胎特征方面。未来的研究应调查双胎中最佳脐带结扎管理方法，以使实践标准化并最大化益处。
