Authors (including presenting author) :
Chan NSR
Affiliation :
Delivery Suite, Obstetrics and Gynaecology, Princess Margaret Hospital
Introduction :
Since 1960s, early cord clamping (ECC) was part of the active management in the third stage of labour. ECC was to clamp the cord within 30 seconds after baby was delivered. Midwives were recommended to perform early cord clamping, controlled cord traction, and use of prophylactic oxytocic drugs to reduce the risk of maternal postpartum haemorrhage or retained placenta. However, in 2012, cord clamping was recommended to be delayed at least 30 seconds or beyond after baby was delivered. Delayed cord clamping (DCC) could allow time for transferring of fetal blood from placenta to the infant, and increase neonatal blood volume at the time of birth.
Objectives :
Nowadays, the eight maternity units of the HA hospitals are practising DCC at normal vaginal delivery. The delayed cord clamping time varies from 30 seconds to no cord pulsation. In order to determine whether the DCC has any short term or long term significant benefit(s) or detrimental effect(s) for mothers or infants, an exhaustive literature review was performed.
Methodology :
The author had followed the PICO* method to formulate the research questions and form the foundation for quality searching. The searching strategies were to retrieve those articles related to umbilical cord, clamping, timing or delay and haemoglobins. The Ovid Medline, CINAHL, Google Scholar, Cochrane Library, PubMed, and Embase databases were searched. All references of retrieved articles were cross-searched. There were 54 articles including the hand search were retrieved from the databases. We excluded those duplicated and irrelevant articles, and only 26 were reviewed by a team of six midwives. Finally 6 articles were chosen as they were more relevant to the research question.
Result & Outcome :
After analysing six relevant articles including nearly 3000 women and their infants, it was suggested that DCC provided more haemoglobin and improved the iron level in infants. More than 30% blood volume and 60% red blood cells could transfuse from placenta to the infant. Infant haemoglobin, haematocrit levels, serum bilirubin and serum ferritin in DCC group was higher than the ECC group. Infants could have less risk of severe anaemia, but the risk of jaundice might be increased. However, contrary to the general belief that ECC could reduce the maternal risk of bleeding after birth, the reviewers found no conclusive evidences. Nevertheless, all the articles are based on overseas data. Therefore, a local retrospective case control study could be recommended.
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