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Online ISSN
1305-3124

Established
1993

Editors-in-Chief
​Cihat Şen, ​Nicola Volpe

Editors
Cecilia Villalain, Daniel Rolnik, M. Mar Gil

Managing Editors
Murat Yayla, Oluş Api

Statistics Editor
Resul Arısoy

The Effect of Cord Clamping Time on Cord Blood Gas in Term Newborn Babies Born by Cesarean Section

Sema Tanriverdi, Burak Pelit, Ibrahim Tekinli

Article info

The Effect of Cord Clamping Time on Cord Blood Gas in Term Newborn Babies Born by Cesarean Section. Perinatal Journal 2023;31(0):- DOI: 10.2399/prn.23.0311001

Author(s) Information

Sema Tanriverdi1,
Burak Pelit2,
Ibrahim Tekinli2

  1. Manisa Celal Bayar University Faculty of Medicine Department of Pediatrics, Division of Neonatology Neonatology Manisa Turkiye
  2. Manisa Celal Bayar University Faculty of Medicine Manisa Celal Bayar University Faculty of Medicine Department of Pediatrics Pediatrics Manisa Turkiye
Correspondence

Sema Tanriverdi, Manisa Celal Bayar University Faculty of Medicine Department of Pediatrics, Division of Neonatology Neonatology Manisa Turkiye, [email protected]

Publication History

Manuscript Received: September 20, 2022

Manuscript Accepted: January 12, 2023

Earlyview Date: January 12, 2023

Conflicts of Interest

No conflicts declared.

Objective
Umbilical cord clamping time is a situation that should be planned before delivery. It is recommended that the umbilical cord be clamped for at least 30-60 seconds after birth in healthy born preterm and term babies. There are few studies investigating the effect of umbilical cord clamping time on cord blood gas. If the umbilical cord is clamped before 30 seconds after birth, it is considered early clamping, and if it is clamped after 30 seconds, it is considered late clamping. In this study, it was aimed to compare the early or late clamping time of the umbilical cord with the acid-base parameters and lactate values of babies.
Methods
A total of 217 term newborn infants who were born by cesarean section between December 2020 and December 2021 in our hospital, whose umbilical cord clamping time was recorded and who had cord blood sample were included in our study retrospectively. pH, pC0₂, p0₂, HC0₃, BE, lactate, Hb and bilirubin values ​​in cord blood gas samples were compared between the two groups.
Results
Two hundred seventeen term newborn babies were included in the study. Cord clamping time of infants was delayed in 125 (57.6%) and early in 92 (42.4%) infants. The mean pH in cord blood gas: 7.37±0.07 (7.16-7.57), pC0₂: 39.73 ±8.97 mmHg (20.3-65.4), p0₂: 53.42±41,95 mmHg (14.8-198), BE: -2.18±2.90 mmol/L (-11.9-13.6), lactate: 2.12±0.88 mmol/L (050-5.90), Hb: 14.57±2.54 g/dl (10-23.7), bilirubin: 1.71±1.33 (0-3.7) mg/dl.



 
Conclusion
There was no significant relationship between early and late clamping of the umbilical cord and acid-base parameters, hemoglobin values in cord blood gas in term newborn babies by cesarean section.

Keywords: umbilical cord, clamping, blood gas
Keywords

umbilical cord, clamping, blood gas

Introduction
The clamping time of the umbilical cord is a situation that should be planned with the obstetrics team in prenatal preparation in the newborn resuscitation program. Delayed cord clamping in term infants is defined as clamping after 3 minutes according to some authors [1,2], while according to some authors it is defined as clamping after cessation of cord pulsation. [3,4] According to the results of the studies, delaying cord clamping in term infants for at least 30-60 seconds (there are publications extending up to 120 seconds) is beneficial in keeping the hemoglobin level and iron stores high in the first months. Therefore, in the recommendations of ACOG updated in 2020, it is recommended that the cord be clamped in term babies after waiting for at least 30-60 seconds after delivery. [5-8]
A delay of 30 to 60 seconds in the umbilical cord can affect cord blood gas values and cause changes in acid-base balance. Cord blood gas analysis is a routine practice that provides information about the condition of the newborn baby before and during birth and is recommended especially in high-risk deliveries. [9-11] There are few studies investigating the effect of delayed clamping of the umbilical cord on cord gas analysis values [11,12]. The aim of this study is to compare the cord blood acid-base parameters and lactate values of infants whose umbilical cord was clamped early and late.
Methods
Our study is a retrospective study. Between December 2020 and December 2021, 901 deliveries occurred in our hospital. Six hundred eighty one of the deliveries were cesarean section. Four hundred six of the cesarean deliveries were term newborns. These 406 babies were screened retrospectively. Of these babies, 217 term babies whose umbilical cord clamping times were recorded and who had cord blood gas samples were included in the study. The remaining 189 babies whose cord blood gas analyzes of were missing or absent, and the time of cord clamping was unknown. Multiple pregnancies, preterm births, babies who need resuscitation, babies with intrauterine growth restriction were not included in the study. Since placenta transfusion may be different between normal vaginal delivery and cesarean delivery, only cesarean deliveries were included in our study. Those who had cord clamping done within the first 30 seconds after birth were considered as the early cord clamped group (ECC), and those who were done after 30 seconds were considered as the late cord clamped group (LCC).
Since it was a retrospective study, it was written as early and late clamping in the baby files. If the umbilical cord clamping time was less than 30 seconds, it was accepted as early clamping, and if it was longer than 30 seconds, it was accepted as late clamping. Clamping times were not written. There were 92 babies in the ECC group and 125 babies in the LCC group. Demographic and antenatal characteristics of the babies were compared. Cord blood gas analysis was evaluated. pH, pC0₂, p0₂, HC0₃, BE, lactate, Hb, bilirubin values ​​in cord blood gas samples were compared between the two groups. A limitation of the present study is that not knowing the hemotological values of the mothers. Our retrospective study was approved by the hospital ethics committee.
In our hospital, the umbilical cord is clamped for at least 30 seconds after birth in healthy term babies. Umbilical blood acid–base and gas analyses are carried out after delivery at our hospital.
Statistical evaluation of the data was carried out using the “SPSS (Statistical Package for Social Sciences) 25.0 for Windows” program. Categorical variables were given as numbers and percentages. Intergroup analyzes of categorical variables were performed using the chi-square test by creating cross tables. Comparisons of two groups in numerical variables were made using the t-test, Mann Whitney U test. A p value <0.05 was considered statistically significant.
Results
A total of 217 infants were included in the study, 125 of which were early cord clamped (ECC) and 92 late cord clamped (LCC). When the demographic characteristics of the babies are examined, the mean gestational age 38.35±0.73 (38-41) weeks, mean birth weight 3230.99±529.07 grams (2010-4690), mean birth length 47.68±2.47 cm (41-54), mean head circumference was 34.15±1.89 cm (30-38). Of the babies, 113 (52.1%) were boys and 104 (47.9%) were girls. Maternal age was 30.34±5.74 (19-44). The reason for cesarean delivery is elective (86 %).The cesarean deliveries received 186 (86 %) spinal anesthesia and 31 (14 %) general anesthesia.
Mean pH in cord blood gas: 7.37±0.07 (7.16-7.57), pC0₂: 39.73 ±8.97 mmHg (20.3-65.4), p0₂: 53.42±41,95 mmHg (14.8-198), BE: -2.18±2.9 mmol/L (-11.9-13.6), lactate: 2.12±0.88 mmol/L (050-5.90), Hb: 14.57±2.54 g/dl (10-23.7), bilirubin: 1.71±1.33 (0-3.7) mg/dl.
Forty-eight (22.1%) of the babies needed intensive care, and 10 (4.6%) received phototherapy treatment. Twenty six (21%) of the babies in the ECC group needed intensive care and 5 (4%) of the babies recevied phototherapy. Twenty two (26%) of the babies in the LCC group needed intensive care and 5(4%) of the babies recevied phototherapy.
When the demographic, clinical and antenatal characteristics of the infants in the ECC and LCC groups were examined, no significant relationship was found between birth weight, type of anesthesia applied during birth, maternal age, apgar scores, hospitalization in the neonatal intensive care unit within the first 24 hours and receiving phototherapy treatment (Table 1).
No significant correlation was found between pH, PC02, P02, Sa02, HC03, BE, lactate, Hb, Bilirubin, glucose values in the cord blood of infants in the ECC and LCC groups (Table 2).
Discussion
Delaying the clamping of the umbilical cord for at least 30-60 seconds in term and healthy preterm infants has been found to have many beneficial effects in the early and late postnatal period. Therefore, in the recommendations of the ACOG updated in 2020, it is recommended that the cord be clamped after waiting for at least 30-60 seconds after delivery in term and healthy preterm babies. [5-8] In our hospital, the umbilical cord is clamped for at least 30 seconds after birth in healthy term and preterm babies.
It has been observed that delayed clamping of the cord increases the newborn's blood volume by 30%. [13] It has been shown that more placental transfusion is achieved with delayed clamping, and higher hemoglobin values ​​without any change in peripheral perfusion. [14] B
In our study, no difference was found between the cord hemoglobin levels of infants with early and late cord clamping. The reason for this was thought to be related to elective cesarean section and delayed clamping time.
Delayed cord clamping is also suitable for respiratory and cardiovascular changes that occur in the first minutes of extrauterine life. In extrauterine life, gas exchange must pass from the placenta to the lungs. Since the airways are filled with fluid during fetal life, gas exchange does not occur in the lungs. A delay in cord clamping allows the neonate to continue receiving a supply of blood, including iron and oxygen. A longer delay has been shown to deliver no extra hematological benefits. [15] Pulmonary blood flow in the fetus is minimal, and high vascular resistance forces blood from the right ventricular outlet to divert blood to the ductus arteriosus and then to the systemic circulation. Clamping the cord separates the fetus from the placenta, reducing venous return to the right atrium and increasing systemic vascular resistance. [14,16] A delay of 30 to 60 seconds in the umbilical cord can affect cord blood gas values and cause changes in acid-base balance. [11] In our study, no change was observed in the acid-base balance of babies with early or late cord clamping. There was no significant difference between pH, pC0₂, p02, Sa0₂, HC0₃, BE, lactate values in cord blood gas of babies whose umbilical cord was clamped early and late. In the study conducted by Anderson et al., it was shown that there was no difference between early and late clamping of the umbilical cord and the values of pH, pC0₂, lactate, HC0₃, BE in the cord blood gas, but the p0₂ value was significantly higher in the late clamped group. In addition, blood samples taken from one of the pulsating umbilical arteries in the late-clamped group and blood samples taken from the cut umbilical cord created with the double-clamp technique were found to have similar pH and acid-base values in blood gases. [12] In the study of Valero et al., it was found that pH, HC0₃, BE, Sa0₂ values were lower, lactate and pC0₂ values were higher, blood glucose values were lower in patients with delayed cord clamping than those with early clamping, and no difference was found between p0₂ values. [11] Similarly, in the study of Wilberg et al., a tendency to metabolic and respiratory acidosis was observed in the blood gas of those who were clamped late, while an increase was found in lactate and p0₂ values. [17] On the other hand, in the study of De Paco et al., it was observed that only the p0₂ value was significantly higher in the group whose umbilical cord was clamped late, and there was no difference between other blood gas parameters. [18] In the study of Künzel et al., no difference was found between the acid-base status of cord blood gas in term newborn babies who underwent early and late cord clamping. [19]
Cord blood gas analysis is a routine practice that provides information about the condition of the newborn baby before and during birth and is recommended especially in high-risk deliveries. [9-11] Blood gas taken from the umbilical cord provides information about fetal physiology at the time of delivery. Cord blood gas analysis is one of the best indicators of the respiratory status of the baby at the time of birth. [20] There are few studies investigating the effect of delayed clamping of the umbilical cord on cord gas analysis values. [11,12]  Delayed clamping of the umbilical cord may cause changes in the infant's respiration and acid-base balance. [11] In our study, no significant difference was found in the cord blood gas analyzes of babies whose umbilical cord was clamped early and late. Our study was performed in term healty neonates with a cesarean delivery and an Apgar score of >5 in the first and fifth minute of life, which would explain the absence of significant differences in acid–base findings between the groups.
Cord blood gas analysis is one of indicators of the metabolic status of the baby at the time of birth. [20] In our study, there was no significant difference between hemoglobin, bilirubin and glucose values measured in cord blood gas. The need for intensive care admission and phototherapy treatment in the first 24 hours were also similar. Since the hemoglobin values between the two groups were similar, the need for phototherapy was also found to be similar.


 
Conclusion
In conclusion, in our study, we found that delayed cord clamping did not cause a significant change in acid-base parameters and hemoglobin values in cord blood gas in term babies born by cesarean section.
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File/Dsecription
the decision of the ethics committee
the decision of the ethics committee
Table 1
Demographic and antenatal characteristics of ECC and LCC groups
Table 2
Cord blood gas values of ECC and LCC groups