{"title":"选择性剖宫产延迟脐带夹紧:一项试点安全试验的结果。","authors":"Caroline J Chantry, Aubrey Blanton, Véronique Taché, Laurel Finta, Daniel Tancredi","doi":"10.1186/s40748-018-0083-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Delayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD).</p><p><strong>Methods: </strong>We enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012-6/2013 for whom DCC was not performed (<i>n</i> = 112).</p><p><strong>Results: </strong>Available data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61-286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), <i>p</i> = 0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, <i>p</i> = 0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL > 800 ml, 21.6% vs. 38.8%, <i>p</i> = 0.07 or b) post-op hgb/pre-op hgb < 80%, 16.7% vs. 20.6%, <i>p</i> = 0.81. There were also no statistically significant between group differences in rates of NICU admission DCC Pilot 8.1% vs. HC 7.1%, <i>p</i> = 1.0., but there was a higher rate of newborn cold stress or hypothermia ≤36.2 °C in study subjects, DCC Pilot 27.0% vs. HC 11.9%, <i>p</i> = 0.038.Prevalence of newborn anemia was decreased [DCC pilot 3.3% (1 of 30) vs. HC 40.0% (4 of 10 infants with data), <i>p</i> = 0.012. No infants were polycythemic.</p><p><strong>Conclusions: </strong>These pilot data suggest cord clamping can be delayed to 120 s during elective CD without increased risk of excessive maternal blood loss. More aggressive prevention of infant heat loss may be warranted. A randomized trial to evaluate long-term maternal and infant outcomes is indicated.</p><p><strong>Trial registration: </strong>Clinical trials.gov, NCT02229162; registered: 1 September, 2014.</p>","PeriodicalId":74120,"journal":{"name":"Maternal health, neonatology and perinatology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s40748-018-0083-3","citationCount":"17","resultStr":"{\"title\":\"Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial.\",\"authors\":\"Caroline J Chantry, Aubrey Blanton, Véronique Taché, Laurel Finta, Daniel Tancredi\",\"doi\":\"10.1186/s40748-018-0083-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Delayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD).</p><p><strong>Methods: </strong>We enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012-6/2013 for whom DCC was not performed (<i>n</i> = 112).</p><p><strong>Results: </strong>Available data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61-286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), <i>p</i> = 0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, <i>p</i> = 0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL > 800 ml, 21.6% vs. 38.8%, <i>p</i> = 0.07 or b) post-op hgb/pre-op hgb < 80%, 16.7% vs. 20.6%, <i>p</i> = 0.81. There were also no statistically significant between group differences in rates of NICU admission DCC Pilot 8.1% vs. HC 7.1%, <i>p</i> = 1.0., but there was a higher rate of newborn cold stress or hypothermia ≤36.2 °C in study subjects, DCC Pilot 27.0% vs. HC 11.9%, <i>p</i> = 0.038.Prevalence of newborn anemia was decreased [DCC pilot 3.3% (1 of 30) vs. HC 40.0% (4 of 10 infants with data), <i>p</i> = 0.012. No infants were polycythemic.</p><p><strong>Conclusions: </strong>These pilot data suggest cord clamping can be delayed to 120 s during elective CD without increased risk of excessive maternal blood loss. More aggressive prevention of infant heat loss may be warranted. A randomized trial to evaluate long-term maternal and infant outcomes is indicated.</p><p><strong>Trial registration: </strong>Clinical trials.gov, NCT02229162; registered: 1 September, 2014.</p>\",\"PeriodicalId\":74120,\"journal\":{\"name\":\"Maternal health, neonatology and perinatology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2018-07-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1186/s40748-018-0083-3\",\"citationCount\":\"17\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Maternal health, neonatology and perinatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s40748-018-0083-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2018/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Maternal health, neonatology and perinatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s40748-018-0083-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2018/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 17
摘要
背景:延迟脐带夹紧(DCC)导致婴儿铁缺乏症减少。美国妇产科学院呼吁对剖宫产(CD)时夹紧脐带的最佳时间进行研究。我们的目的是进行一项试点试验，检查延迟脐带夹紧(DCC)在选择性剖宫产(CD)期间母子二人的安全性。方法:共入组39对[90 s 23对，120 s 16对;(DCC试点)]2013年10月至2014年9月。我们从2012年1月至2013年6月期间未进行DCC的历史对照(HC)分娩的电子病历(EMR)中提取数据(n = 112)。结果:与HC相比，37名母亲和30名婴儿的现有数据显示，产妇平均估计失血量(EBL)平均(SD) mL降低174 (95% CI: 61-286) mL: DCC Pilot 691(218)比HC 864(442)， p = 0.003，产妇输血发生率降低，DCC Pilot 2.7%比HC 18.8%， p = 0.016。DCC Pilot和HC在母体失血过多的其他先验定义中组间无显著差异:a) EBL > 800 ml, 21.6%对38.8%，p = 0.07或b)术后hgb/术前hgb p = 0.81。两组间NICU入院率差异无统计学意义DCC Pilot 8.1% vs HC 7.1%， p = 1.0。但在研究对象中，新生儿冷应激或低温≤36.2°C的发生率较高，DCC Pilot为27.0%，HC为11.9%，p = 0.038。新生儿贫血患病率降低[DCC试点3.3% (1 / 30)，HC试点40.0% (4 / 10)，p = 0.012]。没有婴儿出现红细胞增多。结论:这些试点数据表明，在选择性CD期间，脐带夹紧可以延迟到120秒，而不会增加产妇失血过多的风险。更积极的预防婴儿热损失可能是必要的。一项随机试验，以评估长期产妇和婴儿的结果表明。试验注册:Clinical trials.gov, NCT02229162;注册日期:2014年9月1日。
Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial.
Background: Delayed cord clamping (DCC) results in decreased iron deficiency in infancy. The American College of Obstetrics and Gynecology has called for research on the optimal time to clamp the cord during cesarean deliveries (CD). Our objective was to conduct a pilot trial examining the safety of delayed cord clamping (DCC) for maternal-infant dyads during elective cesarean delivery (CD).
Methods: We enrolled 39 dyads [23 at 90 s, 16 at 120 s; (DCC Pilot)] between 10/2013 and 9/2014. We abstracted data from the electronic medical record (EMR) for historical controls (HC) birthing between 1/2012-6/2013 for whom DCC was not performed (n = 112).
Results: Available data for 37 mothers and 30 infants compared to HC revealed 174 (95% CI: 61-286) mL lower mean estimated maternal blood loss [(EBL) mean (SD) mL]: DCC Pilot 691(218) vs. HC 864(442), p = 0.003 and lower incidence of maternal transfusions, DCC Pilot 2.7% vs. HC 18.8%, p = 0.016. There was no significant between group difference between DCC Pilot and HC in other a priori definitions of excess maternal blood loss: a) EBL > 800 ml, 21.6% vs. 38.8%, p = 0.07 or b) post-op hgb/pre-op hgb < 80%, 16.7% vs. 20.6%, p = 0.81. There were also no statistically significant between group differences in rates of NICU admission DCC Pilot 8.1% vs. HC 7.1%, p = 1.0., but there was a higher rate of newborn cold stress or hypothermia ≤36.2 °C in study subjects, DCC Pilot 27.0% vs. HC 11.9%, p = 0.038.Prevalence of newborn anemia was decreased [DCC pilot 3.3% (1 of 30) vs. HC 40.0% (4 of 10 infants with data), p = 0.012. No infants were polycythemic.
Conclusions: These pilot data suggest cord clamping can be delayed to 120 s during elective CD without increased risk of excessive maternal blood loss. More aggressive prevention of infant heat loss may be warranted. A randomized trial to evaluate long-term maternal and infant outcomes is indicated.
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