Authors (including presenting author) :
SOO WY, OR KL, TANG KY, YEUNG A KM, CHUNG SF, LEUNG WC
Affiliation :
Department of Obstetrics and Gynaecology, Kwong Wah Hospital
Introduction :
Cord clamping after delivery has been a controversial issue over decades. Transition from early cord clamping by preventing maternal postpartum haemorrhage and death, to delayed cord clamping in order to reduce morbidity and promote infant health, changes were giant. According to WHO Guideline (2014), delayed cord clamping for at least one minute is proved to be effective in preventing anaemia, promoting immunity, decrease episodes of intraventricular haemorrhage and necrotic enterocolitis, especially in preterm infants.
Delayed cord clamping practice has been initiated by paediatric unit in Kwong Wah Hospital since 2013 on preterm cases with gestation age of 30 to 35+6 weeks. In view of benefits on placental transfusion, the practice was promoted to term infants as well.
Objectives :
(1) To introduce theory and evidence-based practice on delay cord clamping to midwives; (2) To promote delayed cord clamping, at least one minute, in Kwong Wah Hospital for all term and preterm cases with normal vaginal deliveries since March 2019
Methodology :
A pilot study was performed from January to February in 2019. Two talks were held for over 90% midwives by providing education and information on delayed cord clamping practice. Measures were introduced. Providing warmth and monitoring of infant during delay clamping were emphasized. For normal vaginal deliveries requiring paediatrician or obstetrican standby, consensus is advised before delaying cord clamping.
Exclusive criteria like asphyxia infant, gestational diabetes mellitus, placenta previa, placental abruption and twin pregnancy was adopted due to risk of polycythemia, incomplete placental circulation and high risk cases.
Result & Outcome :
Result:
Rate of delayed cord clamping was 0.86% among normal vaginal delivery in January 2019. After advocate of the practice, there was an obvious rise to 44.54% in March. In December, the rate further rose to 74.18%. Percentage of delay cord clamp in total normal vaginal birth in 2019 was 56.49% in which 56.66% of term and 53.74% of preterm cases.
Delayed cord clamping practice was widely implemented in normal vaginal deliveries. It was well accepted by midwives, paediatricians and obstetricians. During delayed clamping, infants were placed on maternal abdomen to facilitate early skin to skin after cut cord.
Outcome:
Delayed cord clamping was well adopted among both term and preterm infants in normal vaginal deliveries. In view of over thirty percent cases of instrumental delivery and caesarean section, we have no hesitation in further promoting the practice. It is believed that, in mutual collaboration with obstetricians and paediatricans, delay cord clamping would become a usual practice in obstetric unit.
