AUTHOR=Celen Stefanie , Horn-Oudshoorn Emily J. J. , Knol Ronny , Wilk Eline C. van der , Reiss Irwin K. M. , DeKoninck Philip L. J. 

TITLE=Implementation of Delayed Cord Clamping for 3 Min During Term Cesarean Sections Does Not Influence Maternal Blood Loss

JOURNAL=Frontiers in Pediatrics

VOLUME=9

YEAR=2021

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2021.662538

DOI=10.3389/fped.2021.662538

ISSN=2296-2360

ABSTRACT=<p><bold>Background:</bold> To assess maternal safety outcomes after a local protocol adjustment to change the interval of cord clamping to 3 min after term cesarean section.</p><p><bold>Design, Setting, and Patients:</bold> A retrospective cohort study in a tertiary referral hospital (Erasmus MC, Rotterdam). We included pregnant women who gave birth at term after cesarean section. A cohort (Nov 2016–Oct 2017) prior to the protocol implementation was compared to a cohort after its implementation (Nov 2017–Nov 2018). The study population covered 789 women (<italic>n</italic> = 376 pre-cohort; <italic>n</italic> = 413 post-cohort).</p><p><bold>Interventions:</bold> Implementation of a local protocol changing the interval of cord clamping to 3 min in all term births.</p><p><bold>Main outcome measures:</bold> Primary outcomes were the estimated maternal blood loss and the occurrence of postpartum hemorrhage (blood loss &gt;1,000 ml). Secondary outcomes included both maternal as well as neonatal outcomes.</p><p><bold>Results:</bold> Estimated maternal blood loss was not significantly different between the pre-cohort and post-cohort (400 mL [300–600] vs. 400 mL [300–600], <italic>p</italic> = 0.52). The incidence of postpartum hemorrhage (26 [6.9%] vs. 35 (8.5%), OR 1.24, 95% CI 0.73–2.11) and maternal blood transfusion (9 [2%] vs. 13 (3%), OR 1.33, 95% CI 0.56–3.14) were not different. Hemoglobin change was significantly higher in the post-cohort (−0.8 mmol/L [−1.3 to −0.5] vs. −0.9 mmol/L [−1.4 to −0.6], <italic>p</italic> = 0.01). In the post-cohort, neonatal hematocrit levels were higher (51 vs. 55%, <italic>p</italic> = 0.004) and need for phototherapy was increased (OR 1.95, 95% CI 0.99–3.84).</p><p><bold>Conclusion:</bold> Implementation of delayed cord clamping for 3 min in term cesarean sections was not associated with increased maternal bleeding complications.</p>