Letter to the Editor: Early versus delayed umbilical cord clamping on maternal and neonatal outcomes
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CORRESPONDENCE
Letter to the Editor: Early versus delayed umbilical cord clamping on maternal and neonatal outcomes Ayanthi Gunasekera1 · Reena Abraham2 · Christina Neophytou1 · Wai Yoong1 Received: 27 July 2019 / Accepted: 5 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Dear Professor Ortmann, We read with great interest the informative review article by Qian et al. [1] on delayed vs early cord clamping and how this intervention leads higher hemoglobin levels, the improved infants’ and children’s neurodevelopment, and the fewer transfusions, as well as the lower rates of intraventricular hemorrhage (IVH), chronic lung disease, and necrotizing enterocolitis. The review article supports the recommendation on delayed cord clamping (DCC) by the World Health Organisation (WHO), National Institute of Clinical Excellence (NICE), Royal College of Obstetricians and Gynaecologists (RCOG), and the American College of Obstetricians and Gynaecologists (ACOG). Unfortunately, DCC still does not form part of routine third stage of labor protocol in many maternity units and there are barriers to implementing this well-proven intervention in day-to-day clinical practice. We recently conducted an online pilot survey of 19 peer-validated questions on DCC among obstetric trainees in North East and Central London. The survey inquired about respondents’ practice, attitudes, and knowledge about DCC during elective delivery. Of the 50 trainees who responded, 46.5% of respondents were grades ST1–ST4 (junior trainees) and 53.5% of respondents were grades ST5–ST7 (senior trainees). Interestingly, 88.5% claimed that they would have DCC for the birth of their own children. The mean confidence (rated on a 10 cm VAS) in counselling parents about the benefits of DCC was 6.2/10 and 28% of trainees claimed they discussed DCC in the This reply refers to the comment available online at https://doi. org/10.1007/s00404-019-05215-8. * Wai Yoong [email protected] 1
Department of Obstetrics and Gynecology, North Middlesex University Hospital, London N18 1QX, UK
St George’s University School of Medicine, West Indies, Grenada
2
antenatal setting. 56% of the trainees surveyed were aware that postnatal placental transfusion provides an additional 60–80 ml of blood to the neonate, while 58% understood that immediate cord clamping potentially deprives the new born of 20–30 mg/kg of iron. 69% of the respondents were confident that DCC could be carried out in pre-term babies and 90% were confident that DCC could be offered to mothers opting for a water birth. 68% agreed that delayed DCC facilitates early skin-to-skin contact between mother and baby. Regrettably, only 66% of trainees use DCC in their routine clinical practice and quote time constraints, disapproval of senior colleagues and theatre staff as well as simply forgetting to do it (as it is not routine practice) as main reasons for omitting DCC during elective CS. Furthermore, in their last ten elective CS deliveries, the trainees admitted that less than 50% o
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