Current umbilical cord clamping practices and attitudes of obstetricians and midwives toward delayed cord clamping in Saudi Arabia.

Ann Saudi Med. 2017 May-Jun; 37(3): 216–224. doi: 10.5144/0256-4947.2017.216 PMCID: PMC6150582 PMID: 28578361 Current umbilical cord clamping practices and attitudes of obstetricians and midwives toward delayed cord clamping in Saudi Arabia Nadia O. Ibrahim,a Hatouf H. Sukkarieh,a Rami T. Bustami,b Elaf A. Alshammari,a Lama Y. Alasmari,a and Hanan M. Al-Kadria Nadia O. Ibrahim aCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Find articles by Nadia O. Ibrahim Hatouf H. Sukkarieh aCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Find articles by Hatouf H. Sukkarieh Rami T. Bustami bCollege of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Find articles by Rami T. Bustami Elaf A. Alshammari aCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Find articles by Elaf A. Alshammari Lama Y. Alasmari aCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Find articles by Lama Y. Alasmari Hanan M. Al-Kadri aCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Find articles by Hanan M. Al-Kadri Author information Copyright and License information Disclaimer aCollege of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia bCollege of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Correspondence: Dr. Rami T. Bustam, College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, PO Box 3660 Riyadh 11481, Saudi Arabia, as.ude.sh-uask@rimatsub, T: + 966 11 42 95008, F: + 966 11 42 95057, ORCID: http://orcid.org/0000-0003-1418-2274 Copyright © 2017 Annals of Saudi Medicine This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Abstract BACKGROUND In Saudi Arabia, as in many countries, there is usually no clear definition of the timing of umbilical cord clamping (UCC) in the policies and procedures used by hospitals. The World Health Organization (WHO) recommends delayed cord clamping (DCC) (>1 minute after birth) as it can significantly improve hemodynamics and long-term neurodevelopment. OBJECTIVE To investigate current practices of healthcare professionals on the timing of UCC in Saudi Arabia. DESIGN Cross-sectional survey. SETTING Five tertiary hospitals in Riyadh, Saudi Arabia, during May to October 2016. SUBJECTS AND METHODS Obstetricians and midwives completed a widely-used questionnaire on UCC practices. MAIN OUTCOME MEASURE Current UCC practices and attitudes of obstetricians and midwives toward DCC. RESULTS Eighty-two obstetricians and 75 midwives completed the questionnaire for a response rate of 80%. The majority of respondents were aged 30 years or older (81%) and 84% were females. Most respondents were non-Saudi (66%) and had an educational level of bachelor’s degree or higher (72%). Only 42% of respondents reported the existence of UCC guidelines in their practice; 38% reported the existence of a set time for UCC when the neonate was term and healthy, and only 32% had a set time for UCC in preterm neonates. While lower levels of agreement were reported among obstetricians and midwives on the benefits of DCC for babies requiring positive pressure ventilation, the majority of respondents (69–71%) thought that DCC was generally good for both term and preterm babies and that its benefits extend beyond the neonatal period. CONCLUSIONS While the majority of obstetricians and midwives that participated in this study had a positive perception toward DCC, this did not translate to their daily practice as most of these professionals reported a lack of existing UCC guidelines in their institutions. Further studies are warranted to confirm these findings. LIMITATIONS Participant selection by convenience sampling. Umbilical cord clamping (UCC) is an important intervention that is applied routinely after birth. The baby’s umbilical cord is normally clamped and cut. There are different policies on the timing of cord clamping. Early or immediate cord clamping (ICC) is generally done within the first 60 seconds after birth, whereas late or delayed cord clamping (DCC) is carried out more than one minute after birth or when cord pulsation has ceased.1 The blood flow in the umbilical arteries and veins continues for a few minutes after birth. Any additional blood volume which is transferred to the baby after delivery through the placenta is called placental transfusion. It has been found that a 1–3 minute DCC can significantly impact a newborn’s hemodynamics, mainly due to the improved blood volume and the sustained placental respiration.2 During the last century, ICC was the standard practice as it was believed to reduce the likelihood of postpartum hemorrhage (PPH). However, recent studies have shown that early clamping had no clear benefits including prevention of PPH.1,3 In 2012, the World Health Organization (WHO) recommended DCC for all births as a component of the active management of the third stage of labor (AMTSL), while initiating simultaneous essential newborn care.3 WHO recommendations clearly stated that ICC is generally contraindicated, unless the neonate is asphyxiated and needs to be moved immediately for resuscitation.3 Recently, WHO also recommended that in case of newborn resuscitation, the cord should not be clamped earlier than one minute in both newly-born term and preterm babies even when PPV is required.4,5 The transition to systemic and cerebral oxygenation following birth was found to be smoother when the newborn starts spontaneous breathing prior to UCC.6,7 The negative pressure created when the lungs of the infant are inflated at the onset of breathing triggers a significant increase in blood flow to the lungs. This should replace umbilical venous return and substantially increase cardiac output. Therefore, ICC may increase the risk of restricted cardiac output, hypoxia and cardiac respiratory complications, especially if the infant is born with low oxygen levels or other respiratory problems.8 DCC is associated with numerous benefits including increased blood volume, decreased iron deficiency anemia and increased total iron stores by over 50% at 6 months of age. These potential valuable effects are thought to extend beyond the neonatal period, including improvements in long-term neurodevelopment.7–10 Furthermore, it has been found that DCC facilitates transplantation of stem cells into the newborn.9 DCC is associated with a decreased likelihood of red blood cell transfusions compared with ICC.11 In preterm babies, DCC is safe and offers similar hematological benefits and hemodynamic stability. In addition, a number of studies have reported that DCC can re (...truncated)