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Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery
JAMA ( IF 63.1 ) Pub Date : 2019-11-19 , DOI: 10.1001/jama.2019.15995 Stephanie E Purisch 1 , Cande V Ananth 2, 3, 4 , Brittany Arditi 1, 5 , Logan Mauney 1, 6 , Barouyr Ajemian 1 , Amy Heiderich 1 , Tina Leone 1 , Cynthia Gyamfi-Bannerman 1
JAMA ( IF 63.1 ) Pub Date : 2019-11-19 , DOI: 10.1001/jama.2019.15995 Stephanie E Purisch 1 , Cande V Ananth 2, 3, 4 , Brittany Arditi 1, 5 , Logan Mauney 1, 6 , Barouyr Ajemian 1 , Amy Heiderich 1 , Tina Leone 1 , Cynthia Gyamfi-Bannerman 1
Affiliation
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Importance
The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in term neonates for at least 30 to 60 seconds after birth. Most literature supporting this practice is from low-risk vaginal deliveries. There are no published data specific to cesarean delivery. Objective
To compare maternal blood loss with immediate cord clamping vs delayed cord clamping in scheduled cesarean deliveries at term (≥37 weeks). Design, Setting, and Participants
Randomized clinical trial performed at 2 hospitals within a tertiary academic medical center in New York City from October 2017 to February 2018 (follow-up completed March 15, 2018). A total of 113 women undergoing scheduled cesarean delivery of term singleton gestations were included. Interventions
In the immediate cord clamping group (n = 56), cord clamping was within 15 seconds after birth. In the delayed cord clamping group (n = 57), cord clamping was at 60 seconds after birth. Main Outcomes and Measures
The primary outcome was change in maternal hemoglobin level from preoperative to postoperative day 1, which was used as a proxy for maternal blood loss. Secondary outcomes included neonatal hemoglobin level at 24 to 72 hours of life. Results
All of the 113 women who were randomized (mean [SD] age, 32.6 [5.2] years) completed the trial. The mean preoperative hemoglobin level was 12.0 g/dL in the delayed and 11.6 g/dL in the immediate cord clamping group. The mean postoperative day 1 hemoglobin level was 10.1 g/dL in the delayed group and 9.8 g/dL in the immediate group. There was no significant difference in the primary outcome, with a mean hemoglobin change of -1.90 g/dL (95% CI, -2.14 to -1.66) and -1.78 g/dL (95% CI, -2.03 to -1.54) in the delayed and immediate cord clamping groups, respectively (mean difference, 0.12 g/dL [95% CI, -0.22 to 0.46]; P = .49). Of 19 prespecified secondary outcomes analyzed, 15 showed no significant difference. The mean neonatal hemoglobin level, available for 90 neonates (79.6%), was significantly higher with delayed (18.1 g/dL [95% CI, 17.4 to 18.8]) compared with immediate (16.4 g/dL [95% CI, 15.9 to 17.0]) cord clamping (mean difference, 1.67 g/dL [95% CI, 0.75 to 2.59]; P < .001). There was 1 unplanned hysterectomy in each group. Conclusions and Relevance
Among women undergoing scheduled cesarean delivery of term singleton pregnancies, delayed umbilical cord clamping, compared with immediate cord clamping, resulted in no significant difference in the change in maternal hemoglobin level at postoperative day 1. Trial Registration
ClinicalTrials.gov Identifier: NCT03150641.
中文翻译：
延迟与立即脐带钳夹对足月剖宫产中产妇失血量的影响
重要性 美国妇产科医师学会建议在出生后至少延迟 30 至 60 秒对足月新生儿进行脐带钳夹。大多数支持这种做法的文献来自低风险的阴道分娩。没有专门针对剖宫产的已发表数据。目的 比较在足月（≥37 周）计划剖宫产中立即夹脐与延迟夹脐的母体失血量。设计、设置和参与者 2017 年 10 月至 2018 年 2 月在纽约市一家三级学术医疗中心的 2 家医院进行的随机临床试验（随访于 2018 年 3 月 15 日完成）。共纳入了 113 名接受预定剖宫产的足月单胎妊娠妇女。干预措施 在直接夹脐组（n = 56）中，脐带夹在出生后 15 秒内。在延迟脐带钳夹组（n = 57）中，脐带钳夹是在出生后 60 秒进行的。主要结果和措施 主要结果是从术前到术后第 1 天母体血红蛋白水平的变化，用作母体失血量的代表。次要结局包括出生后 24 至 72 小时的新生儿血红蛋白水平。结果 所有随机分配的 113 名女性（平均 [SD] 年龄，32.6 [5.2] 岁）均完成了试验。延迟脐带钳夹组的平均术前血红蛋白水平为 12.0 g/dL，而立即夹钳组为 11.6 g/dL。延迟组术后第 1 天的平均血红蛋白水平为 10.1 g/dL，即刻组为 9.8 g/dL。主要结果没有显着差异，平均血红蛋白变化为 -1.90 g/dL（95% CI，-2. 延迟和即刻脐带钳夹组分别为 14 至 -1.66) 和 -1.78 g/dL（95% CI，-2.03 至 -1.54）（平均差异，0.12 g/dL [95% CI，-0.22 至 0.46] ; P = .49）。在分析的 19 个预先指定的次要结果中，15 个没有显着差异。90 名新生儿 (79.6%) 的平均新生儿血红蛋白水平显着高于延迟 (18.1 g/dL [95% CI, 17.4 至 18.8]) 与立即 (16.4 g/dL [95% CI, 15.9 至 18.8]) 相比。 17.0]) 脐带钳夹（平均差异，1.67 g/dL [95% CI，0.75 至 2.59]；P < .001）。每组有 1 次计划外子宫切除术。结论和相关性 在计划剖宫产的足月单胎妊娠妇女中，延迟脐带钳夹与立即脐带钳夹相比，
更新日期：2019-11-19
中文翻译：
延迟与立即脐带钳夹对足月剖宫产中产妇失血量的影响
重要性 美国妇产科医师学会建议在出生后至少延迟 30 至 60 秒对足月新生儿进行脐带钳夹。大多数支持这种做法的文献来自低风险的阴道分娩。没有专门针对剖宫产的已发表数据。目的 比较在足月（≥37 周）计划剖宫产中立即夹脐与延迟夹脐的母体失血量。设计、设置和参与者 2017 年 10 月至 2018 年 2 月在纽约市一家三级学术医疗中心的 2 家医院进行的随机临床试验（随访于 2018 年 3 月 15 日完成）。共纳入了 113 名接受预定剖宫产的足月单胎妊娠妇女。干预措施 在直接夹脐组（n = 56）中，脐带夹在出生后 15 秒内。在延迟脐带钳夹组（n = 57）中，脐带钳夹是在出生后 60 秒进行的。主要结果和措施 主要结果是从术前到术后第 1 天母体血红蛋白水平的变化，用作母体失血量的代表。次要结局包括出生后 24 至 72 小时的新生儿血红蛋白水平。结果 所有随机分配的 113 名女性（平均 [SD] 年龄，32.6 [5.2] 岁）均完成了试验。延迟脐带钳夹组的平均术前血红蛋白水平为 12.0 g/dL，而立即夹钳组为 11.6 g/dL。延迟组术后第 1 天的平均血红蛋白水平为 10.1 g/dL，即刻组为 9.8 g/dL。主要结果没有显着差异，平均血红蛋白变化为 -1.90 g/dL（95% CI，-2. 延迟和即刻脐带钳夹组分别为 14 至 -1.66) 和 -1.78 g/dL（95% CI，-2.03 至 -1.54）（平均差异，0.12 g/dL [95% CI，-0.22 至 0.46] ; P = .49）。在分析的 19 个预先指定的次要结果中，15 个没有显着差异。90 名新生儿 (79.6%) 的平均新生儿血红蛋白水平显着高于延迟 (18.1 g/dL [95% CI, 17.4 至 18.8]) 与立即 (16.4 g/dL [95% CI, 15.9 至 18.8]) 相比。 17.0]) 脐带钳夹（平均差异，1.67 g/dL [95% CI，0.75 至 2.59]；P < .001）。每组有 1 次计划外子宫切除术。结论和相关性 在计划剖宫产的足月单胎妊娠妇女中，延迟脐带钳夹与立即脐带钳夹相比，
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