Authors: Jombo S E, Eifediyi R A, Kayode-Adedeji B A, Eigbefoh JO
Optimal timing of the clamping and cutting of the umbilical cord is yet to be clearly established, however evidence favours delayed umbilical cord clamping as it is beneficial with potential minimal or no risk to the mother and the baby. The evaluation of this cost effective, easy and practicable procedure especially in our settings where it is highly needed has not been done. Objective of the study is to assess maternal and neonatal outcomes of delayed versus early umbilical cord clamping in Irrua specialist teaching hospital. A prospective, three-armed, single Centre randomized controlled (open label) trials.234 participants were randomized into A, B and C arms, representing ECC within 30 seconds of birth, DCC at 2 minutes and three minutes for A, B and C arms respectively. Data was analyzed with the statistical package for social sciences (SPSS) version 20.0 IBM. Statistical comparison was done using Fisher’s exact test for three groups and Student’s t- test for two groups that are continuous variables while Chi-Square test was used for categorical variables. The level of significance was accepted when P-value is equal to or less than 0.05 and confident interval of 95%. Primary outcomes were maternal bloodloss post-partum and neonatal PCV, serum ferritin, transcutaneous bilirubin estimation/ serum bilirubin at 48 hours after birth and the infant’s packed cell volume and serum ferritinat six weeks post-delivery. Secondary outcomes were maternal PPH and neonatal anaemia, jaundice, SBCU admission, phototherapy and EBT. In addition placenta weight and umbilical cord length were compared across groups with maternal satisfaction. 234 mothers-babies pairs were randomized into three groups A, B and C with 6.8% drop out rate, hence 218 mothers-babies pairs were analyzed out of which;75(34.4 %) for group A, 72 (33.0%) for group B and 71(32.6%) for group C. Thebaby’s mean PCV and serum ferritins were higher in the DCC than ECC at 48 hours(F=61.0, P= <0.001 and F= 150.0, P= <0.001 respectively) which remained higher in DCC groups as compared to ECC group, at six weeks follow up after delivery (F=7.1, P= 0.001 and F= 379.1, P= <0.001 respectively). All the babies in group A (ECC) had anaemia which was 36 % or less in DCC groups. There was no significant difference between the three groups in respect to maternal blood loss, hyperbilirubinaemia, SCBU admission, and need for phototherapy. Delayed umbilical cord clamping for two minutes is better than ECC and is equally effective as DCC for three minutes. A follow up of cases with hyperbilirubinaemia showed a strong association to ABO incompatibility especially among group O Rh D positive mothers ( X2 = 11.7, P = 0.011). It has been concluded that Delayed umbilical cord clamping is beneficial rather than harmful as it ensures higher packed cell volume and serum ferritin to the newborn even up to six weeks after birth at no maternal or neonatal risk. Two minutes of delay in umbilical cord clamping after birth is strongly recommended as an ideal optimal time for cord clamping in our rural setting.
Cord clamping, Placenta weight, cord length, maternal- neonatal outcomes.
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