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Peberdy L, Young J, Massey D, Kearney L. Australian maternity healthcare professionals' knowledge, attitudes and practices relevant to cord blood banking, donation and clamp timing: A cross-sectional survey. Women Birth 2020; 34:e584-e591. [PMID: 33309477 DOI: 10.1016/j.wombi.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/31/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
PROBLEM Australian health professionals' knowledge and attitudes towards third stage labour options of cord clamp timing, cord blood banking and donation and their practice of informing parents of these options is unknown. BACKGROUND Parents have several options for the management of their infant' cord blood during the third stage of labour. Early or deferred cord clamping practices may affect parent choices about physiological transfusion to the neonate and/or cord blood collection for private or public banking or donation. AIM To identify health professionals' knowledge and attitudes towards third stage labour options of cord clamp timing, cord blood banking and donation and their practice of informing parents of these options. METHODS A total of 129 Australian maternity healthcare professionals responded to the self-administered survey between December 2017 and June 2018. FINDINGS Occupational differences were revealed in regard to cord clamp timing, cord blood banking and donation knowledge, attitudes and practices. Midwives were more likely to discuss cord clamp timing with parents and to clamp the cord later than obstetricians. Obstetricians were more knowledgeable of cord blood banking and donation options than midwives. Cord blood banking and donation options were discussed by both groups if parents asked. DISCUSSION Identification of gaps in knowledge should guide future maternity health professional education that is inclusive of all third stage labour options to ensure that open discussion and informing parents of options is consistent, contemporary and evidence-based. CONCLUSION To make informed decisions, parents need evidence-based information on all third stage labour options.
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Affiliation(s)
- Lisa Peberdy
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Jeanine Young
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Debbie Massey
- Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga, Queensland, 4225, Australia.
| | - Lauren Kearney
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
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2
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Peberdy L, Young J, Massey D, Kearney L. Maternity health professionals' perspectives of cord clamp timing, cord blood banking and cord blood donation: a qualitative study. BMC Pregnancy Childbirth 2020; 20:410. [PMID: 32677904 PMCID: PMC7364524 DOI: 10.1186/s12884-020-03102-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Parents today have several options for the management of their infant’s cord blood during the third stage of labour. Parents can choose to have their infant’s cord clamped early or to have deferred cord clamping. If the cord is clamped early, cord blood can be collected for private cord blood banking or public cord blood donation for use later if needed. If cord clamping is deferred, the placental blood physiologically transfuses to the neonate and there are physiological advantages to this. These benefits include a smoother cardiovascular transition and increased haemoglobin levels while not interfering with the practice of collecting cord blood for gases if needed. The aim of this study is to explore Australian maternity health professionals’ perspectives towards cord clamp timing, cord blood banking and cord blood donation. Methods Fourteen maternity health professionals (midwives and obstetricians) from both private and public practice settings in Australia participated in semi-structured interviews either in person or by telephone. Interviews were transcribed and data analysed using thematic analysis. Results Overall there was strong support for deferred cord clamping, and this was seen as important and routinely discussed with parents as part of antenatal care. However, support did not extend to the options of cord blood banking and donation and to routinely informing parents of these options even when these were available at their birthing location. Conclusion Formalised education for maternity health professionals is needed about the benefits and implications of cord blood banking and cord blood donation so that they have the confidence to openly discuss all options of cord clamp timing, cord blood banking and cord blood donation to facilitate informed decision-making by parents.
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Affiliation(s)
- Lisa Peberdy
- Clinical Nursing - Maternal, Child and Family Health, The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Jeanine Young
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia
| | - Debbie Massey
- Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga, Queensland, 4225, Australia
| | - Lauren Kearney
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia
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Gönenç İM, Aker MN, Ay E. Qualitative Study on the Experience of Lotus Birth. J Obstet Gynecol Neonatal Nurs 2019; 48:645-653. [PMID: 31563441 DOI: 10.1016/j.jogn.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the experiences of women who had lotus births, that is, leaving the umbilical cord uncut so that the placenta remains attached to the newborn until the umbilical cord naturally detaches. DESIGN Descriptive phenomenological. SETTING Seven cities in four geographic regions of Turkey. PARTICIPANTS Nine women who experienced lotus birth. METHODS Data were collected through semistructured, face-to-face interviews. RESULTS Our analysis revealed six themes: Meaning of the Lotus Birth Experience, Decision Making Regarding Lotus Birth, Lotus Birth Process, Perceived Benefits and Disadvantages of Lotus Birth, Reactions to Lotus Birth, and The Future of Lotus Birth. In addition, we created 15 subthemes related to these overarching themes. CONCLUSIONS The themes we extracted are reflective of the desire for a natural and healthy birth that is experienced as positive and beneficial. Our results contribute to a deeper and more nuanced understanding of lotus birth. Moreover, our findings provide women and all health care providers, especially maternity nurses, with valuable information and increased awareness of lotus birth.
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Anton O, Jordan H, Rabe H. Strategies for implementing placental transfusion at birth: A systematic review. Birth 2019; 46:411-427. [PMID: 30264508 DOI: 10.1111/birt.12398] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Enhanced placental transfusion reduces adverse neonatal outcomes, including death. Despite being endorsed by the World Health Organization in 2012, the method has not been adopted widely in practice. METHODS We performed a systematic literature search and included quality improvement projects on placental transfusion at birth and studies on barriers to implementation. We extracted information on population, methods of implementation, obstacles to implementation, and strategies to overcome them. RESULTS We screened 99 studies out of which 18 were included in the review. The preferred methods of implementation were protocol development (86% of studies) reinforced by targeted education (64% of studies) and multidisciplinary team involvement (43% of studies). Barriers to implementation were mentioned in 12 studies and divided into four categories: general factors such as lack of staff awareness (5 studies) and professional resistance to change (5 studies); obstetrician-specific concerns, including the impact during cesarean (3 studies) and the risk of postpartum hemorrhage (3 studies); pediatrician-specific concerns, including the need for resuscitation (5 studies), risk of jaundice (3 studies), and polycythemia (2 studies); and logistical difficulties. The main strategies to facilitate placental transfusion at birth included effective multidisciplinary team collaboration, protocol development, targeted education, and constructive feedback sessions. CONCLUSIONS Placental transfusion implementation requires a multidisciplinary approach, with obstetricians, midwives, nurses, and pediatricians central to adoption of the practice. Understanding the obstacles to implementation informs strategies to increase placental transfusion adoption of practice worldwide. We suggest a stepwise approach to implementation and enhancement of placental transfusion into practice.
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Affiliation(s)
- Oana Anton
- Academic Department of Paediatrics, Brighton and Sussex University Hospitals, Royal Alexandra Hospital for Children, Brighton, UK
| | - Harriet Jordan
- Academic Department of Paediatrics, Brighton and Sussex University Hospitals, Royal Alexandra Hospital for Children, Brighton, UK
| | - Heike Rabe
- Academic Department of Paediatrics, Brighton and Sussex University Hospitals, Royal Alexandra Hospital for Children, Brighton, UK.,Academic Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
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Lodha A, Shah PS, Soraisham AS, Rabi Y, Abou Mehrem A, Singhal N. Association of Deferred vs Immediate Cord Clamping With Severe Neurological Injury and Survival in Extremely Low-Gestational-Age Neonates. JAMA Netw Open 2019; 2:e191286. [PMID: 30924898 PMCID: PMC6450317 DOI: 10.1001/jamanetworkopen.2019.1286] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Deferred cord clamping (DCC) is recommended for term and preterm neonates to reduce neonatal complications. Information on the association of DCC with outcomes for extremely low-gestational-age neonates is limited. OBJECTIVE To compare neonatal outcomes after DCC and immediate cord clamping (ICC) in extremely low-gestational-age neonates. DESIGN, SETTING, AND PARTICIPANTS In this retrospective cohort study, eligible neonates born between January 1, 2011, and December 31, 2015, were divided into 2 groups: DCC and ICC. Neonates were recruited from tertiary neonatal intensive care units participating in the Canadian Neonatal Network, and analysis began in January 2018. Neonates were eligible if they were born at 22 to 28 weeks' gestational age and admitted to a participating Canadian Neonatal Network neonatal intensive care unit during the study period. Neonates who were born outside a tertiary-level neonatal intensive care unit, were moribund at birth, needed palliative care before delivery, had major congenital anomalies, or lacked cord clamping information were excluded. MAIN OUTCOMES AND MEASURES Composite of severe neurological injury (intraventricular hemorrhage grade ≥3 with or without persistent periventricular echogenicity) or mortality before discharge. RESULTS Of 8221 admitted neonates, 4680 were included in the study, of whom 1852 (39.6%) received DCC and 2828 (60.4%) received ICC. There were 974 (52.7%) male neonates in the DCC group and 1540 (54.5%) male neonates in the ICC group. Median (interquartile range) gestational age was 27 (25-28) weeks for the DCC group and 26 (25-27) weeks for the ICC group. Median (interquartile range) birth weight was 930 (760-1120) g and 870 (700-1060) g for DCC and ICC groups, respectively. Neonates who received DCC had significantly reduced odds of the composite outcome of severe neurological injury or mortality (adjusted odds ratio [AOR], 0.80; 95% CI, 0.67-0.96), mortality (AOR, 0.74; 95% CI, 0.59-0.93), and severe neurological injury (AOR, 0.80; 95% CI, 0.64-0.99). The odds of bronchopulmonary dysplasia (AOR, 1.00; 95% CI, 0.84-1.19), retinopathy of prematurity stage 3 or higher (AOR, 0.94; 95% CI, 0.71-1.25), necrotizing enterocolitis stage 2 or higher (AOR, 0.86; 95% CI, 0.66-1.12), late-onset sepsis (AOR, 1.02; 95% CI, 0.85-1.22), and receipt of 2 or more blood transfusions (AOR, 0.93; 95% CI, 0.79-1.10) did not differ between the groups. Propensity score-matched analyses revealed lower odds of mortality (AOR, 0.79; 95% CI, 0.65-0.95), late-onset sepsis (AOR, 0.81; 95% CI, 0.69-0.95), and treatment for hypotension (AOR, 0.75; 95% CI, 0.60-0.95) in the DCC group. CONCLUSIONS AND RELEVANCE In this study of extremely low-gestational-age neonates who received DCC or ICC, DCC was associated with reduced risk for the composite outcome of severe neurological injury or mortality.
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MESH Headings
- Delivery, Obstetric/adverse effects
- Delivery, Obstetric/mortality
- Female
- Humans
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/mortality
- Nervous System Diseases/epidemiology
- Nervous System Diseases/etiology
- Nervous System Diseases/mortality
- Pregnancy
- Retrospective Studies
- Umbilical Cord/physiology
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Affiliation(s)
- Abhay Lodha
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Prakesh S. Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Amuchou Singh Soraisham
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Yacov Rabi
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Nelin V, Kc A, Andersson O, Rana N, Målqvist M. Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal. BMC Res Notes 2018; 11:89. [PMID: 29386046 PMCID: PMC5793403 DOI: 10.1186/s13104-018-3198-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Abstract
Objective Delayed umbilical cord clamping (DCC) (≥ 60 s) is recognized to improve iron status and neurodevelopment compared to early umbilical cord clamping. The aim of this study is to identify current umbilical cord clamping practice and factors determining the timing of clamping in a low-resource setting where prevalence of anemia in infants is high. Results A cross-sectional study design including 128 observations of clinical practice in a tertiary-level maternity hospital in Kathmandu, Nepal. Overall 48% of infants received DCC. The mean and median cord clamping times were 61 ± 33 and 57 (38–79) s, respectively. Univariate analysis showed that infants born during the night shift were five times more likely to receive DCC (OR 5.6, 95% CI 1.4–38.0). Additionally, infants born after an obstetric complication were 2.5 times more likely to receive DCC (OR 2.5, 95% CI 1.2–5.3), and babies requiring ventilation had a 65% lower likelihood of receiving DCC (OR 0.35, 95% CI 0.13–0.88). Despite the existence of standard protocols for cord clamping and its proven benefit, the lack of uniformity in the timing of cord clamping reveals poor translation of clinical guidelines into clinical practice. Clinical trial registration ISRCTN97846009 Electronic supplementary material The online version of this article (10.1186/s13104-018-3198-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Viktoria Nelin
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, 751 85, Uppsala, Sweden
| | - Ashish Kc
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, 751 85, Uppsala, Sweden.,United Nation's Children's Fund (UNICEF), Nepal Country Office, UN House, Pulchowk, Kathmandu, Nepal
| | - Ola Andersson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, 751 85, Uppsala, Sweden
| | - Nisha Rana
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, 751 85, Uppsala, Sweden
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, 751 85, Uppsala, Sweden.
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Leslie MS, Erickson‐Owens D, Cseh M. The Evolution of Individual Maternity Care Providers to Delayed Cord Clamping: Is It the Evidence? J Midwifery Womens Health 2015; 60:561-9. [DOI: 10.1111/jmwh.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Immediate clamping and cutting of the umbilical cord at birth has been the accepted standard of care for decades. The physiologic rationale relating umbilical cord clamping (UCC) to the events of the circulatory transition is not considered in arbitrarily recommended cord clamping times. Systematic review of early versus deferred UCC shows significant hemodynamic benefits to the deferred group. Mechanisms for this protective effect are considered in this review. The original concept of a placental transfusion with a volume load and prevention of low cardiac output relies on the physiological end point of the amount of blood transfused. The newer concept of an ordered physiological transition is increasingly supported. This model places aeration of the lungs and an increase in pulmonary blood flow back at the centre of the circulatory transition with timing of UCC being related to establishment of respiration. The need for "physiologically based" UCC is discussed.
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Affiliation(s)
- Martin Kluckow
- University of Sydney and Royal North Shore Hospital, Sydney, Australia.
| | - Stuart B Hooper
- The Ritchie Centre, MIMR-PHI Institute for Medical Research, Monash University, Melbourne, Australia
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9
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Immediate versus delayed cord clamping. Am J Obstet Gynecol 2015; 212:827-8. [PMID: 25757634 DOI: 10.1016/j.ajog.2015.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/04/2015] [Indexed: 11/20/2022]
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Abstract
Delivery room management, especially in the first 'golden' minute, is of the utmost importance. An exact and universal definition of when a baby is born is needed to obtain agreement on what is meant by the first minute of life. Education of young girls is a basic requirement to optimize the health of the mother and baby. Interventions in pregnancy should as far as possible be evidence based. Antenatal care, the selection of birth mode and antenatal steroid therapy when indicated also contribute to obtaining the best outcome. Delayed cord clamping is recommended for both preterm and term infants. However, more data are needed regarding the most immature infants. Routine suctioning of the mouth and airways is not required. Thermal control is important - keep the temperature in the delivery room at 26°C and wrap infants <28 weeks of gestation in plastic. However, this procedure does not reduce mortality. Since delayed cord clamping increases mean birth weight by approximately 30 g/kg, the present birth weight charts based on early clamping need to be corrected. Preterm infants in need of ventilatory support should start with CPAP from the first breath. A T-piece device seems to have some advantages compared to self-inflating bags. Surfactant instillation is often not needed prophylactically provided the mother has received antenatal steroids. Less invasive methods for administering surfactant may be useful. If ventilatory support is needed, start with air in term and near-term infants. For babies of 29-33 weeks of gestation start with 21-30% oxygen and for infants <29 weeks start with 30% oxygen and adjust according to the response obtained.
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Affiliation(s)
- Ola Didrik Saugstad
- Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway
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Abstract
Third stage practice, including the timing of cord clamping and its impact on neonatal health, has been comprehensively reviewed previously by Downey and Bewley, and this opinion will focus on the evidence about neonatal transition which has been published since. Many professional organisations and experts recommend at least a 30-second delay before clamping the umbilical cord, especially after preterm births.
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