695 - Cord clamping time and placental transfusion in cesarean sections: an observational multicenter study.

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 695
Publication Number: 695.444

Jenny Svedenkrans, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Stockholm, Stockholms Lan, Sweden; Anna Sand, Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Stockholms Lan, Sweden; Deborah Utjés, Karolinska University Hospital, Stockholm, Stockholms Lan, Sweden; Ola Andersson, Lund University, Halmstad, Hallands Lan, Sweden

Presenting Author(s)

Jenny Svedenkrans, MD, PhD (she/her/hers)

Senior Consultant Neonatologist
Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University
Stockholm, Stockholms Lan, Sweden

Background: To delay cord clamping implicates several advantages for the infant, including increased placental transfusion, improved iron stores and improved neurodevelopment. These positive effects may also benefit infants in need of cardiovascular resuscitation at vaginal and cesarean deliveries. The knowledge about further delayed cord clamping and placental transfusion at cesarean sections is however scarce.

Objective:

To prepare for a study on intact cord resuscitation, the effect of cord clamping time on placental transfusion in elective, as well as emergency cesarean sections, was evaluated. Furthermore, negative short-term side effects of delayed cord clamping were analyzed.

Design/Methods: Prospective observational study on cesarean deliveries at 35 gestational weeks or later. Indication for cesarean section, cord clamping time, timing of uterotonics administration and estimated maternal blood loss were recorded at birth. Placentas were drained from remaining blood, which was weighed and registered as an indirect proxy for placental transfusion. The relation between cord clamping time, remaining placental blood volume and maternal blood loss was analyzed.

Results:

Measurements were available for 143 placentas. Of these, 24 (16.8%) were delivered after emergency cesarean section. Median (IQR) cord clamping time was 68 (56-91) sec, mean (SD) remaining blood in the placenta was 35.5 (28.8) g. There was a significant negative correlation between cord clamping time in minutes and remaining placental blood in an adjusted linear regression model (B=-9.2, p=0.005, figure 1). There was no correlation between cord clamping time and maternal blood loss (B=1,5 p=0.12). Administration of uterotonics before cord clamping was associated with less residual placental blood volume (mean difference 13.4 ml, p=0.008, figure 2). No difference was found between emergency and elective cesarean sections.

Conclusion(s):

An expectant management of cord clamping may enhance placental transfusion in cesarean sections without increased maternal blood loss. Timing of uterotonics administration may affect placental transfusion. Larger studies are needed to evaluate the importance of indication for cesarean section.