Study of delayed cord clamping (DCC) versus physiological cord clamping (PCC) in management of child birth

ISSN Print – 2454-2334; ISSN Online – 2454-2342 DOI - 10.21276/obgyn.2023.10.1.9 RESEARCH ARTICLE Study of delayed cord clamping (DCC) versus physiological cord clamping (PCC) in management of child birth Shrinivas N Gadappa, Sonali S Deshpande, Dhanashree R Lahane Corresponding author: Dr. Dhanashree R Lahane, Assistant Professor, Department Of OBGY, GMCH, Aurangabad, India; Email: Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Objectives: To compare the effect of delayed cord clamping (DCC) versus physiological cord clamping (PCC) on third stage of labour and fetal outcome. Methodology: This is arandomized controlled trial. Participants were randomly assigned to control group (DCC) receiving cord clamping after 1 minute of delivery of baby and the study group (PCC) receiving cord clamping after delivery of placenta. Maternal and early neonatal outcome was analyzed and compared between the two groups by appropriate statistical test. Result: Baseline maternal characteristics were comparable in both groups. The duration of third stage of labour was higher in PCC, but no significant increase in incidence of PPH, no need of additional uterotonic and no need for blood transfusion was observed. Average FHR was normal in both the groups with FHR at 1 minute higher in PCC group and FHR at 5 minutes higher in DCC group. The fetal temperature was comparable in both groups. The mean Apgar score was higher in PCC group than DCC. Fetal haemoglobin and hematocrit values were also higher in PCC group. Conclusion: PCC is safe, effective and cost-free intervention for neonatal health benefits and should be implemented in the term and pre term infants, even in resource poor settings, where it might offer a sustainable strategy to prevent transient tachypnia of new born (TTA), hypothermia and may prevent long term anemia in new born without increasing the maternal risk of third stage complication. Keywords: Anaemia, delayed cord clamping, neonatal hypothermia, neonatal jaundice, physiological cord clamping, post partum haemorrhage. There has been debate for centuries regarding, when to clamp and cut the umbilical cord of the newly born infant, practices have ranged from one extreme to the other. From the time of the ancient Greeks, midwives have described the value of waiting to clamp the cord until pulsations stop or until the placenta is delivered 1. Committee on neonatal resuscitation recommended delayed cord clamping for infants who do not require immediate resuscitation 2, and the World Health Organization (WHO) has also reiterated their recommendation to delay cord clamping (DCC) for 1-3 minutes while initiating simultaneous essential newborn care 3. Yet, all the current practice guidelines vary in their emphasis and details; but it should also be noted that all of them do suggest that delayed cord clamping may not be feasible or desirable in every situation, especially when immediate resuscitation is required. The Ministry of Health and Family Welfare, Government of India issued an advisory (dated November 6, 2019) on deferring cord clamping until delivery of placenta (known as physiological cord clamping) as a part of an initiative to promote physiological childbirth in healthy pregnant women, who have no identified risk factors for themselves or their babies 4. Active management of labour involves prophylactic oxytocin administration (either IV or IM) followed by clamping the cord 1-3 minutes after birth and controlled cord traction 5. The physiological care includes facilitating a comfortable, warm environment; encouraging an upright position to facilitate birth of placenta; refraining from fundal Received: 24th October 2021, Peer review completed: 22th March 2022, Accepted: 6th April 2022. Gadappa SN, Deshpande SS, Lahane DR. Study of delayed cord clamping (DCC) versus physiological cord clamping (PCC) in management of child birth. The New Indian Journal of OBGYN. 2023; 10(1): 54 - 59. The New Indian Journal of OBGYN. 2023 (July-December);10(1) massage; paying close attention to signs of excessive blood loss; being mindful for direct and indirect signs of placental separation, facilitating immediate skin-to-skin contact with newborn and early breastfeeding 6. Government Medical College and Hospital, Aurangabad has pioneered implementation of respectful maternity care services to all pregnant women. As a part of this initiative, one of the key interventions is to provide quality care with dignity and equity to every pregnant woman visiting the hospital. We started implementing physiological care to give mothers the joy of giving birth in a natural way, in a desirable position and in the presence of a birth companion of their choice, aiding early initiation of breast feeding with better fetal outcome physiologically with minimum medical intervention. The added benefits for the baby include increase in iron stores, more stem cells (resulting in stronger immune system), improved development and cognitive performance of the child along with better cardio-respiratory stability and a smoother transition to extra uterine life 4. Our institution is a tertiary care center catering high as well as low risk pregnant women from nearby area. The available data from many studies compared beneficial effects of physiological cord clamping for new born health but concern remains regarding potential maternal complications (PPH, retained placenta) and excess placental transfusion. Furthermore, the physiological cord clamping advisory was for only for uncomplicated pregnancies. Hence, the present study was undertaken to compare the maternal and early neonatal outcome in early cord clamping versus physiological cord clamping in low risk as well as hemodynamically stable high-risk pregnancies. Materials and methods Study place: Department of obstetrics and gynaecology GMCH, Aurangabad. Duration of study: 6 months (November 2019- May 2020). Sample size: Sample size was calculated by using Open Epi software - PCC group (A) :1000; DCC group (B) : 1000. Study design: Randomized controlled trial, participants were randomly assigned to one of two parallel groups with a 1:1 ratio, with DCC group receiving cord clamping after 1 minutes of delivery of baby and the PCC group receiving cord clamping after delivery of placenta. Inclusion criteria: All pregnant women coming to labour room with: 1. Gestational age >34 weeks. 2. Single live fetus. 3. Fetal heart rate between 120-160 beats/minute for normal delivery. 4. Willing to participate in the study. Exclusion criteria: Maternal risk factors like: 1. Maternal haemodynamic instability, 2. Abnormal placentation (abruption / placenta previa/adherent placenta), 3. Rh negative blood group, 4. Mothers requiring blood transfusion during labour before delivery, 5. Sero - positive status of mothers, 6. Mothers undergoing caesarean section, 7. Gestational age < 34 weeks , 8. Multiple gestation, 9. Nee (...truncated)