The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean-delivered term newborns without fetal distress: a prospective observational study

被引:23
作者
Giovannini, N. [1 ]
Crippa, B. L. [2 ,3 ]
Denaro, E. [1 ]
Raffaeli, G. [2 ]
Cortesi, V. [2 ,3 ]
Consonni, D. [4 ]
Cetera, G. E. [1 ]
Parazzini, F. [1 ]
Ferrazzi, E. [1 ,3 ]
Mosca, F. [2 ,3 ]
Ghirardello, S. [2 ]
机构
[1] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Obstet & Gynaecol, Milan, Italy
[2] Fdn IRCCS Ca Granda Osped Maggiore Policlin, NICU, Milan, Italy
[3] Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy
[4] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Epidemiol Unit, Milan, Italy
关键词
Anaemia; assisted vaginal delivery; caesarean section delivery; fetal monitoring; obstetric haemorrhage; neonatal; ACID-BASE STATUS; SECTION; INFANT; RESUSCITATION; TRANSFUSION; TRANSITION; ANESTHESIA; GUIDELINES; PLACENTA; SAMPLES;
D O I
10.1111/1471-0528.16026
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objective To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress. Design Prospective observational study. Setting University hospital. Sample CBG from 97 VDs and 124 CDs without fetal distress. Methods Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs. Main outcome measures Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO(2)), partial pressure of carbon dioxide (pCO(2)), pH, and postpartum haemorrhage. Results Arterial cord blood pH, bicarbonate (HCO3-, mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P HCO3- = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P HCO3- = 26.2 versus 27.2; P P < 0.001). After 3-minute DCC, pCO(2) increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs [lactate, +1.1 (0.9, 1.45) versus +0.5 (-0.65, 2.35) P = 0.01]. Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit. Conclusions After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs. Tweetable abstract By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.
引用
收藏
页码:405 / 413
页数:9
相关论文
共 38 条
  • [1] ACOG Committee on Obstetric Practice, 2006, Obstet Gynecol, V108, P1319
  • [2] A policy of routine umbilical cord blood gas analysis decreased missing samples from high-risk births
    Ahlberg, M.
    Elvander, C.
    Johansson, S.
    Cnattingius, S.
    Stephansson, O.
    [J]. ACTA PAEDIATRICA, 2017, 106 (01) : 43 - 48
  • [3] Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial
    Andersson, Ola
    Hellstrom-Westas, Lena
    Andersson, Dan
    Clausen, Jesper
    Domellof, Magnus
    [J]. ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, 2013, 92 (05) : 567 - 574
  • [4] [Anonymous], S AUSTR PERINATAL PR
  • [5] Armstrong L, 2007, ARCH DIS CHILD-FETAL, V92, P430
  • [6] Wait a minute? An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60-and 180-second umbilical cord clamping
    Askelof, Ulrica
    Andersson, Ola
    Domellof, Magnus
    Fasth, Anders
    Hallberg, Boubou
    Hellstrom-Westas, Lena
    Pettersson, Karin
    Westgren, Magnus
    Wiklund, Ingela E.
    Gotherstrom, Cecilia
    [J]. BMJ OPEN, 2017, 7 (12):
  • [7] QUANTILE REGRESSION-OPPORTUNITIES AND CHALLENGES FROM A USER'S PERSPECTIVE
    Beyerlein, Andreas
    [J]. AMERICAN JOURNAL OF EPIDEMIOLOGY, 2014, 180 (03) : 330 - 331
  • [8] Umbilical blood flow patterns directly after birth before delayed cord clamping
    Boere, I.
    Roest, A. A. W.
    Wallace, E.
    ten Harkel, A. D. J.
    Haak, M. C.
    Morley, C. J.
    Hooper, S. B.
    te Pas, A. B.
    [J]. ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 2015, 100 (02): : F121 - F125
  • [9] Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial
    Caroline J. Chantry
    Aubrey Blanton
    Véronique Taché
    Laurel Finta
    Daniel Tancredi
    [J]. Maternal Health, Neonatology and Perinatology, 4 (1)
  • [10] Timing of Umbilical Cord Clamping After Birth
    不详
    [J]. OBSTETRICS AND GYNECOLOGY, 2012, 120 (06) : 1522 - 1526