Intervention Review

You have free access to this content

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes

  1. Susan J McDonald1,*,
  2. Philippa Middleton2,
  3. Therese Dowswell3,
  4. Peter S Morris4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 11 JUL 2013

Assessed as up-to-date: 14 MAR 2013

DOI: 10.1002/14651858.CD004074.pub3


How to Cite

McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3.

Author Information

  1. 1

    La Trobe University/Mercy Hospital for Women, Midwifery Professorial Unit, Melbourne, Victoria, Australia

  2. 2

    The University of Adelaide, Women's and Children's Health Research Institute, Adelaide, South Australia, Australia

  3. 3

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

  4. 4

    Menzies School of Health Research, Charles Darwin University, Child Health Division, Darwin, Northern Territory, Australia

*Susan J McDonald, Midwifery Professorial Unit, La Trobe University/Mercy Hospital for Women, Level 4, Room 4.071, 163 Studley Road, Heidelberg, Melbourne, Victoria, 3084, Australia. s.mcdonald@latrobe.edu.au. sue.mcdonald@mercy.com.au.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 11 JUL 2013

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

Background

Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord more than one minute after the birth or when cord pulsation has ceased. The benefits and potential harms of each policy are debated.

Objectives

To determine the effects of early cord clamping compared with late cord clamping after birth on maternal and neonatal outcomes

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013).

Selection criteria

Randomised controlled trials comparing early and late cord clamping.

Data collection and analysis

Two review authors independently assessed trial eligibility and quality and extracted data.

Main results

We included 15 trials involving a total of 3911 women and infant pairs. We judged the trials to have an overall moderate risk of bias.

Maternal outcomes: No studies in this review reported on maternal death or on severe maternal morbidity. There were no significant differences between early versus late cord clamping groups for the primary outcome of severe postpartum haemorrhage (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.65 to 1.65; five trials with data for 2066 women with a late clamping event rate (LCER) of ˜3.5%, I2 0%) or for postpartum haemorrhage of 500 mL or more (RR 1.17 95% CI 0.94 to 1.44; five trials, 2260 women with a LCER of ˜12%, I2 0%). There were no significant differences between subgroups depending on the use of uterotonic drugs. Mean blood loss was reported in only two trials with data for 1345 women, with no significant differences seen between groups; or for maternal haemoglobin values (mean difference (MD) -0.12 g/dL; 95% CI -0.30 to 0.06, I2 0%) at 24 to 72 hours after the birth in three trials.

Neonatal outcomes: There were no significant differences between early and late clamping for the primary outcome of neonatal mortality (RR 0.37, 95% CI 0.04 to 3.41, two trials, 381 infants with a LCER of ˜1%), or for most other neonatal morbidity outcomes, such as Apgar score less than seven at five minutes or admission to the special care nursery or neonatal intensive care unit. Mean birthweight was significantly higher in the late, compared with early, cord clamping (101 g increase 95% CI 45 to 157, random-effects model, 12 trials, 3139 infants, I2 62%). Fewer infants in the early cord clamping group required phototherapy for jaundice than in the late cord clamping group (RR 0.62, 95% CI 0.41 to 0.96, data from seven trials, 2324 infants with a LCER of 4.36%, I2 0%). Haemoglobin concentration in infants at 24 to 48 hours was significantly lower in the early cord clamping group (MD -1.49 g/dL, 95% CI -1.78 to -1.21; 884 infants, I2 59%). This difference in haemoglobin concentration was not seen at subsequent assessments. However, improvement in iron stores appeared to persist, with infants in the early cord clamping over twice as likely to be iron deficient at three to six months compared with infants whose cord clamping was delayed (RR 2.65 95% CI 1.04 to 6.73, five trials, 1152 infants, I2 82%). In the only trial to report longer-term neurodevelopmental outcomes so far, no overall differences between early and late clamping were seen for Ages and Stages Questionnaire scores.

Authors' conclusions

A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

Effect of timing of umbilical cord clamping of term infants on mother and baby outcomes

At the time of birth, the infant is still attached to the mother via the umbilical cord, which is part of the placenta. The infant is usually separated from the placenta by clamping the cord. This clamping is one part of the third stage of labour (the time from birth of the baby until delivery of the placenta) and the timing can vary according to clinical policy and practice. Although early cord clamping has been thought to reduce the risk of bleeding after birth (postpartum haemorrhage), this review of 15 randomised trials involving a total of 3911 women and infant pairs showed no significant difference in postpartum haemorrhage rates when early and late cord clamping (generally between one and three minutes) were compared. There were, however, some potentially important advantages of delayed cord clamping in healthy term infants, such as higher birthweight, early haemoglobin concentration, and increased iron reserves up to six months after birth. These need to be balanced against a small additional risk of jaundice in newborns that requires phototherapy.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

足月新生儿脐带钳夹的时机对产妇和新生儿结局的影响

研究背景

脐带钳夹时机包括:早期脐带钳夹即分娩后60秒内钳夹,晚期脐带钳夹即分娩后超过1分钟或脐带搏动停止后钳夹。两种方式的优劣尚存争议。

研究目的

为确定早期和晚期钳夹脐带对母婴结局的影响

检索策略

我们检索了Cochrane妊娠和分娩组临床试验注册库(Cochrane Pregnancy and Childbirth Group's Trials Register) (2013年2月13日)。

标准/纳入排除标准

早期和晚期脐带钳夹对比的随机对照试验。

数据收集与分析

两位检索者独立评估试验的纳入标准和试验质量以及数据提取。

主要结果

我们纳入涉及3911对母婴的15个试验。所纳入试验总体存在中度偏倚风险。

产妇结局:本综述无文献报道孕产妇死亡或严重的孕产妇并发症。 早期和晚期脐带钳夹组在严重的产后出血结局(RR 1.04, 95% CI 0.65 ~1.65; 5个试验中2260名产妇晚期脐带钳夹率 (LCER)~3.5%, I20%),或产后出血量达到或超过500ml (RR 1.17 95% CI 0.94 ~ 1.44; 5个试验中2260名产妇LCER ~12%, I20%) 的比较无明显差异。使用促宫缩药物的亚组间比较差异无显著性。 仅2个试验1345名产妇报道平均失血量,或3个试验产妇产后24-72小时的血红蛋白量(平均差(MD)-0.12 g/dL; 95% CI -0.30 ~ 0.06, I20%)组间比较差异无显著性。

新生儿结局:早期和晚期脐带钳夹对于新生儿死亡或其它主要的新生儿并发症,例如:5分钟Apgar评分低于7分,或需要特殊护理者,或需要进入新生儿重症监护室者的差异无显著性(RR 0.37, 95% CI 0.04 ~3.41, 2个试验, 381 名新生儿 晚期脐带钳夹率 ~1%)。和早期脐带钳夹者相比,晚期脐带钳夹之新生儿平均出生体重较高(增加101克,95% CI 45 ~157,随机效应模型,12个试验,3139名新生儿,I262%)。 和晚期脐带钳夹者相比,早期脐带钳夹之新生儿因黄疸需光照疗法者数量较少(RR 0.62, 95% CI 0.41 - 0.96, 7个试验, 2324 名新生儿晚期脐带钳夹率 4.36%, I20%)。 出生24-48小时早期脐带钳夹之新生儿血红蛋白浓度低于晚期脐带钳夹组(MD -1.49g/dL, 95% CI -1.78 ~ -1.21; 884 infants, I259%), 该血红蛋白浓度的差异在后续评估中消失。但是,和晚期脐带钳夹者相比,早期脐带钳夹可改善新生儿体内的铁储备至产后3~6个月缺铁时的2倍(RR 2.65 95% CI 1.04 ~ 6.73, 5个试验, 1152 名新生儿, I282%)。 仅有1个试验报道了新生儿的远期的神经发育结局,在早期和晚期的脐带钳夹按年龄和阶段的问卷调查评分差异无显著性。

作者结论

延迟健康足月新生儿脐带钳夹的处理措施是可信的,特别是越来越多的证据表明延迟脐带钳夹有利于增加新生儿早期血红蛋白浓度和铁储备。 只要具备治疗黄疸的光照疗法的条件,延迟脐带钳夹是有益的治疗措施。

翻译注解

译者:伍玲、黄志超(香港中文大学妇产科);审校:李迅。翻译由北京中医药大学循证医学中心组织与提供。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

足月新生儿脐带钳夹的时机对母亲和婴儿结局的影响

胎儿娩出后,新生儿仍以脐带与母体相连,钳夹脐带后新生儿与胎盘分离。在第三产程中(胎儿娩出到胎盘娩出的时期)钳夹脐带的时机随临床政策与实践的不同而改变。尽管分娩后早期钳夹脐带曾被认为可以减少分娩后出血(产后出血),但是本综述包括3911对母婴在内的15个随机试验证实分娩后早期或晚期钳夹脐带(一般在1~3分钟内)与产后出血率的高低无显著差异。健康足月新生儿晚期钳夹脐带的潜在优势包括:高出生体重和血红蛋白浓缩,以及增加新生儿出生半年内体内的铁储备,但也增加了新生儿黄疸的发病风险以及光照疗法的应用。

翻译注解

译者:伍玲、黄志超(香港中文大学妇产科);审校:李迅。翻译由北京中医药大学循证医学中心组织与提供。

 

Laienverständliche Zusammenfassung

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

Die zeitliche Koordinierung des Abklemmens der Nabelschnur bei Neugeborenen und ihre Wirkung auf Studienendpunkte bei Mutter und Baby

Bei der Geburt ist das Neugeborene noch über die Nabelschnur, welche einen Teil des Mutterkuchens (der Plazenta) bildet, mit der Mutter verbunden. Das Neugeborene wird normalerweise durch das Abklemmen der Nabelschnur von der Plazenta getrennt. Das Abklemmen ist Teil der dritten Geburtsphase, d.h. der Zeit zwischen der Geburt des Babys und der Ausscheidung der Plazenta (Nachgeburt), wobei der Zeitpunkt je nach klinischer Richtlinie und Praxis unterschiedlich sein kann. Bisher wurde angenommen, dass das frühe Abklemmen der Nabelschnur das Risiko einer Blutung nach der Geburt (Nachgeburtsblutung) vermindert. Gleichwohl konnte der vorliegende Review mit 15 eingeschlossenen randomisierten Studien an insgesamt 3911 Müttern mit ihren Neugeborenen keine signifikanten Unterschiede in der Häufigkeit von Nachgeburtsblutungs finden, wenn frühes und spätes Abklemmen der Nabelschnur verglichen wurde. Das späte Abklemmen fand dabei in der Regel in einem Zeitraum von ein bis drei Minuten nach der Geburt statt. Es ergaben sich jedoch einige möglicherweise wichtigen Vorteile eines späten Abklemmens der Nabelschnur bei gesunden Säuglingen, beispielsweise ein höheres Geburtsgewicht, eine frühe Hämoglobinkonzentration und größere Eisenreserven bis zu sechs Monate nach der Geburt. Diesen Vorteilen steht ein kleines zusätzliches Risiko für eine Neugeborenen-Gelbsucht gegenüber, die eine Behandlung mit Lichttherapie erfordert.

Anmerkungen zur Übersetzung

Cochrane Schweiz

 

Laički sažetak

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

Učinak vremena podvezivanja pupčane vrpce u djece rođene na termin na ishode majke i djeteta

Nakon porođaja dijete je još uvijek pričvršćeno za majku putem pupčane vrpce, koja je dio posteljice. Dijete se od posteljice obično razdvaja podvezivanjem pupčane vrpce. To podvezivanje dio je trećeg porođajnog doba (vrijeme od rođenja djeteta do porođaja posteljice). Iako se smatralo kako rano podvezivanje pupčane vrpce smanjuje rizik od krvarenja nakon porođaja (postpartalna hemoragija), ovaj je Cochrane sustavni pregled, u koji je uključeno 15 randomiziranih kliničkih istraživanja s ukupno 3911 parova žena i djece, pokazao da nema značajne razlike u krvarenju nakon porođaja između ranog i kasnog podvezivanja pupčane vrpce (usporedba između podvezivanja jednu ili tri minute nakon porođaja). Međutim, uočene su određene potencijalno važne prednosti odgođenog podvezivanja pupčane vrpce u zdrave djece rođene na termin, kao što su veća porođajna težina, veća rana koncentracija hemoglobina i veće rezerve željeza do 6 mjeseci nakon porođaja. Uočene prednosti treba razmotriti u svjetlu malog dodatnog rizika od žutice u novorođenčadi, zbog čega djetetu može biti potrebna terapija svjetlom (fototerapija).

Bilješke prijevoda

Prevoditelj:: Croatian Branch of the Italian Cochrane Centre

 

Ringkasan bahasa mudah

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

Kesan masa apitan tali pusat bayi cukup bulan terhadap ibu dan bayi.

Semasa lahir, bayi masih lagi bersambung dengan ibu melalui tali pusat, yang merupakan sebahagian daripada uri. Bayi tersebut biasanya terpisah daripada uri apabila tali pusat diapit. Proses apitan ini merupakan salah satu bahagian peringkat ketiga proses bersalin (masa dari kelahiran bayi sehinggalah lahirnya uri) dan masa tersebut boleh berubah mengikut polisi klinikal dan praktik. Walaupun pengapitan awal tali pusat telah dianggap dapat mengurangkan risiko pendarahan selepas bersalin (pendarahan postpartum), namun, kajian semula ini yang merangkumi 15 percubaan terawak yang melibatkan sejumlah 3911 pasangan wanita dan bayi baru lahir menunjukkan tidak ada perbezaan ketara dalam kadar pendarahan postpartum apabila pengapitan awal dan lewat (secara umumnya antara satu hingga tiga minit) dibandingkan. Walau bagaimanapun, pengapitan lewat tali pusat berpotensi memberi beberapa manfaat penting untuk bayi baru lahir yang sihat and cukup bulan, misalnya berat masa lahir yang lebih tinggi, kepekatan hemoglobin awal dan peningkatan simpanan zat besi sehingga enam bulan selepas lahir. Manfaat-manfaat ini perlu diimbangkan dengan tambahan risiko kecil bayi baru lahir mendapat penyakit kuning (jaundis) yang memerlukan rawatan cahaya.

Catatan terjemahan

Diterjemahkan oleh Nursyahirah binti Johari (Melaka Manipal Medical College). Disunting oleh Tan May Loong (Penang Medical College). Untuk sebarang pertanyaan sila hubungi nursyahirahjohari@gmail.com

 

Резюме на простом языке

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Laienverständliche Zusammenfassung
  7. Laički sažetak
  8. Ringkasan bahasa mudah
  9. Резюме на простом языке

Влияние сроков пережатия пуповины у доношенных новорожденных на исходы для матери и ребенка

К моменту рождения младенец всё ещё привязан к матери через пуповину, являющуюся частью плаценты. Младенца, как правило, отделяют от плаценты, пережимая пуповину. Это пережатие пуповины является частью третьего периода родов (время от рождения ребенка до рождения плаценты), сроки которого могут варьировать в зависимости от политики клиники и практики. Несмотря на то, что в основе рекомендаций раннего пережатия пуповины лежит мысль уменьшения риска послеродового кровотечения, этот обзор, включающий 15 рандомизированных клинических испытаний с участием в общей сложности 3911 пар женщин и младенцев, показал отсутствие существенной разницы в частоте послеродового кровотечения в зависимости от раннего или позднего пережатия пуповины (главным образом, от одной до трех минут). Однако были выявлены некоторые потенциально важные преимущества отсроченного пережатия пуповины у здоровых доношенных младенцев, такие, как более высокая масса тела при рождении, ранняя концентрация гемоглобина и увеличение запасов железа до шести месяцев после рождения. Это должно быть соотнесено с дополнительным невысоким риском желтухи у этих новорожденных, которая требуют проведения фототерапии.

Заметки по переводу

Заметки по переводу:  Перевод: Гамирова Римма Габдульбаровна. Редактирование: Кораблева Анна Александровна, Зиганшина Лилия Евгеньевна. Координация проекта по переводу на русский язык: Казанский федеральный университет. По вопросам, связанным с этим переводом, пожалуйста, свяжитесь с нами по адресу: lezign@gmail.com