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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (01) : 67 -72. doi: 10.3877/cma.j.issn.1673-5250.2022.01.009

论著

基于全国性问卷调查的延迟脐带结扎影响因素分析
朱娟娟1,1, 古航2,2, 王蓓3,3, 韩树萍4,4, 朱建幸1,1, 谢利娟1,†,1()   
  • 收稿日期:2021-09-23 修回日期:2021-11-22 出版日期:2022-02-01
  • 通信作者: 谢利娟

Influencing factors on delayed cord clamping: based on the national questionnaire survey

Juanjuan Zhu1,1, Hang Gu2,2, Bei Wang3,3, Shuping Han4,4, Jianxing Zhu1,1, Lijuan Xie1,1,†()   

  • Received:2021-09-23 Revised:2021-11-22 Published:2022-02-01
  • Corresponding author: Lijuan Xie
  • Supported by:
    Natural Science Foundation of Shanghai(12ZR1419600); Clinical Science and Technology Innovation Project of Shanghai Shen Kang Hospital(SHDC12016217)
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朱娟娟, 古航, 王蓓, 韩树萍, 朱建幸, 谢利娟. 基于全国性问卷调查的延迟脐带结扎影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(01): 67-72.

Juanjuan Zhu, Hang Gu, Bei Wang, Shuping Han, Jianxing Zhu, Lijuan Xie. Influencing factors on delayed cord clamping: based on the national questionnaire survey[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(01): 67-72.

目的

探讨我国新生儿脐带结扎(UCC)现状及实施延迟脐带结扎(DCC)影响因素。

方法

采用分层随机抽样法，在我国华南、华北、华东、华中、西北、西南和东北7个地区中，以2∶1比例随机抽取2~3个省，共计16个省的126家医院。以这126家医院工作的新生儿科医师、产科医师及助产士/师为调查对象。本研究自行设计《新生儿娩出后脐带结扎方式调查问卷》(以下简称为《调查问卷》)。《调查问卷》主要包括3个方面内容：①被调查对象的一般资料；②被调查对象对DCC的认知程度；③被调查对象认为影响DCC实施因素等。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

结果

①最终回收《调查问卷》为5 005份，其中，来自综合性医院的符合填写要求《调查问卷》为2 280份(45.55%)，妇幼保健院为2 725份(54.25%)。5 005份《调查问卷》中，由助产士/师、产科医师、新生儿科医师填写分别为2 253份(45.01%)，1 541份(30.79%)和1 211份(24.20%)。②回收的5 005份《调查问卷》中，知晓DCC相关知识者为4 325位(86.41%)，实施者仅为921位(18.40%)。③被调查者主要从专家讲座(62.87%)、科室规范(53.50%)、文献检索(42.94%)和国际指南(40.00%)等途径获取有关DCC相关知识。④对DCC实施影响因素的多因素非条件logistic回归分析结果显示，医院类型(OR＝0.530, 95%CI：0.355~0.837，P＝0.006)，医院等级(OR＝0.450，95%CI：0.364~0.556，P<0.001)，分娩方式(OR＝35.772，95%CI：20.753~61.660，P<0.001)，是否早产(OR＝3.914，95%CI：2.178~7.033，P<0.001)，认为操作是否便捷(OR＝2.577，95%CI：0.001~0.014，P<0.001)，是否有科室规范(OR＝1.187，95%CI：0.767~0.838，P＝0.015)和认为能否便于新生儿窒息复苏(OR＝0.021，95%CI：0.010~0.142，P<0.001)是DCC实施的影响因素(P<0.05)。

结论

目前，临床工作者对DCC的知晓率高，但实施率低。临床实施DCC的影响因素较多，在中国建立明确的实施DCC指南或专家共识，对优化产科新生儿分娩的UCC临床实践非常必要。

关键词: 脐带, 立即脐带结扎, 延迟脐带结扎, 调查和问卷, 影响因素分析, 指南, 婴儿，新生
Objective

To explore current status of umbilical cord clamping (UCC) and influencing factors of delayed cord clamping (DCC) in China.

Methods

Respondents of neonatologists, obstetricians and midwives/teachers worked in 126 hospitals of 16 provinces were randomly selected from 2-3 provinces and municipality directly under Central Government in 7 regions of South, North, East, and Central, Northwest, Southwest, Northeast China at a ratio of 2∶1 by stratified random sampling method. Questionnaire on the Umbilical Cord Method after the Delivery (hereinafter referred to as Questionnaire) was self-designed. It mainly included three aspects: ①general information of respondents; ②awareness rate of respondents to DCC; ③factors that respondents thought to affect on implementation of DCC. The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013.

Results

① A total of 5 005 questionnaires were collected in this survey, including 2 280 (45.55%) in general hospitals and 2 725 (54.25%) in maternal and child health hospitals. There were 2 253 (45.01%), 1 541 (30.79%) and 1 211 (24.20%) completed by midwives, obstetricians and neonatologists respectively. ②Among the 5 005 questionnaires, 4 325 (86.41%) respondents knew about DCC, and only 921 (18.40%) implemented it. ③Respondents obtained DCC-related knowledge through mainly expert lectures (62.87%), departmental standards (53.50%), literature retrieval (42.94%) and international guidelines (40.00%). ④The results of multivariate unconditional logistic regression analysis on related influencing factors on implementation of DCC showed that hospital category (OR=0.530, 95%CI: 0.355-0.837, P=0.006), hospital grade (OR=0.450, 95%CI: 0.364-0.556, P<0.001) and neonatal delivery mode (OR=35.772, 95%CI: 20.753-61.660, P<0.001), premature newborns (OR=3.914, 95%CI: 2.178-7.033, P<0.001), and whether it was easy to operate (OR=2.577, 95%CI: 0.001-0.014, P<0.001), standardization of clinica department (OR=1.187, 95%CI: 0.767-0.838, P=0.015), application of neonatal asphyxia resuscitation (OR=0.021, 95%CI: 0.010-0.142, P<0.001) were influencing factors of implementation of DCC (P<0.05).

Conclusions

The awareness rate of respondents to DCC after newborns delivered is at a high level, but real implementation rate is low. There are many factors influencing on clinical implementation of DCC. It is necessary to establish clear guidelines or expert consensus to optimize to clinical practice of DCC in China.

Key words: Umbilical cord, Immediate cord clamping, Delayed cord clamping, Surveys and questionnaires, Root cause analysis, Guidebooks, Infant, newborn
图1 《新生儿娩出后脐带结扎方式调查问卷》被调查对象分布图
表1 不同等级、类型医院及被调查人员对新生儿娩出后DCC的知晓和实施情况比较[位(%)]
被调查人员 被调查人数 医院等级 医院类型 被调查者职业
二级 三级 综合性医院 妇幼保健院 助产士/师 产科医师 新生儿科医师
知晓未实施 3 404 1 277(37.5) 2 127(62.5) 1 568(46.1) 1 836(53.9) 1 414(41.4) 1 167(34.3) 823(24.2)
知晓并实施 921 301(32.7) 620(67.3) 315(34.2) 606(65.8) 604(65.6) 212(23.0) 105(11.4)
χ2值   4.776 27.184 63.241
P值   0.031 <0.001 0.017
图2 本《调查问卷》被调查对象获取DCC相关知识的途径注：DCC为延迟脐带结扎。WHO为世界卫生组织
表2 DCC实施相关影响因素的非条件多因素logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
综合性医院(以妇幼保健院为对照) -0.635 0.233 7.421 0.006 0.530 0.355~0.837
二级医院(以三级医院为对照) -0.798 0.108 54.612 <0.001 0.450 0.364~0.556
有科室规范(以无科室规范为对照) 1.171 0.223 0.509 0.015 1.187 0.767~0.838
早产(以足月产为对照) 1.365 0.299 20.824 <0.001 3.914 2.178~7.033
剖宫产术分娩(以经阴道分娩为对照) 3.577 0.278 165.880 <0.001 35.772 20.753~61.660
认为操作便捷(以认为不便捷为对照) 0.947 0.220 18.509 <0.001 2.577 0.001~0.014
认为能预防PPH(以认为不能预防PPH为对照) 0.911 0.062 218.934 0.992 2.486 0.012~1.059
认为能便于窒息复苏(以认为不便于窒息复苏为对照) -3.887 0.371 109.866 <0.001 0.021 0.010~0.142
常数项 2.387 0.132 256.972 <0.001 1.215 —
[1]
Finer N. 50 years ago in the journal of pediatrics: cardiopulmonary effects of placental transfusion[J]. J Pediatr, 2015, 167(2): 291. DOI: 10.1016/j.jpeds.2015.01.049.
[2]
Rabe H, Diaz-Rossello JL, Duley L, et al. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes[J]. Cochrane Database Syst Rev, 2019, 9: CD003248. DOI: 10.1002/14651858.CD003248.
[3]
Farrar D, Airey R, Law GR, et al. Measuring placental transfusion for term births: weighing babies with cord intact[J]. BJOG, 2011, 118(1): 70-75. DOI: 10.1111/j.1471-0528.2010.02781.x.
[4]
Jelin AC, Kuppermann M, Erickson K, et al. Obstetricians′ attitudes and beliefs regarding umbilical cord clamping[J]. J Matern Fetal Neonatal Med, 2014, 27(14): 1457-1461. DOI: 10.3109/14767058.2013.864275.
[5]
Leslie MS, Greene J, Schulkin J, et al. Umbilical cord clamping practices of U．S. obstetricians[J]. J Neonatal Perinatal Med, 2018, 11(1): 51-60. DOI: 10.3233/NPM-181729.
[6]
Guideline: delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes[M]. Geneva: World Health Organization, 2014.
[7]
American College of Obstetricians and Gynecologists′ Committee on Obstetric Practice. Delayed umbilical cord clamping after birth: ACOG Committee Opinion, Number 814[J]. Obstet Gynecol, 2020，136(6)：e100-e106. DOI: 10.1097/AOG.0000000000004167.
[8]
Carnielli V, Sweet DG, Greisen G, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome: 2019 update[J]. Neonatology, 2019, 115(4): 432-450. DOI: 10.1159/000499361.
[9]
Zhu J, Xie Y, Wang B, et al. Epidemiological investigation on the current practice of umbilical cord clamping in China[J]. Am J Perinatol, 2020, DOI: 10.1055/s-0040-1721494.
[10]
中华人民共和国国家卫生健康委员会. 全国医疗机构查询[DB/OL]．[2021-01-08].

URL    
[11]
Gams RL, Popp KK, Cramer J, et al. How to engage your team to implement delayed cord clamping[J]. Nurs Womens Health, 2017, 21(6): 489-498. DOI: 10.1016/j.nwh.2017.10.003.
[12]
Boere I, Smit M, Roest AA, et al. Current practice of cord clamping in the Netherlands: a questionnaire study[J]. Neonatology, 2015, 107(1): 50-55. DOI: 10.1159/000365836.
[13]
Zhou YB, Li HT, Zhu LP, et al. Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: a systematic review and Meta-analysis[J]. Placenta, 2014, 35(1): 1-8. DOI: 10.1016/j.placenta.2013.10.011.
[14]
Gomersall J, Berber S, Middleton P, et al. Umbilical cord management at term and late preterm birth: a Meta-analysis[J]. Pediatrics, 2021, 147(3): e2020015404. DOI: 10.1542/peds.2020-015404.
[15]
Vesoulis ZA, Rhoades J, Muniyandi P, et al. Delayed cord clamping and inotrope use in preterm infants[J]. J Matern Fetal Neonatal Med, 2018，31(10)：1327-1334. DOI: 10.1080/14767058.2017.1315663.
[16]
Backes CH, Huang H, Iams JD, et al. Timing of umbilical cord clamping among infants born at 22 through 27 weeks′ gestation[J]. J Perinatol, 2016, 36(1): 35-40. DOI: 10.1038/jp.2015.117.
[17]
McAdams RM. Time to implement delayed cord clamping[J]. Obstet Gynecol, 2014, 123(3): 549-552. DOI: 10.1097/AOG.0000000000000122.
[18]
Dierikx T, Berkhout D, Eck A, et al. Influence of timing of maternal antibiotic administration during caesarean section on infant microbial colonisation: a randomised controlled trial[J]. Gut, 2021：324767, DOI: 10.1136/gutjnl-2021-324767.
[19]
Yao AC, Moinian M, Lind J. Distribution of blood between infant and placenta after birth[J]. Lancet, 1969, 2(7626): 871-873. DOI: 10.1016/s0140-6736(69)92328-9.
[20]
Boere I, Roest AA, Wallace E, et al. Umbilical blood flow patterns directly after birth before delayed cord clamping[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(2): F121-F125. DOI: 10.1136/archdischild-2014-307144.
[21]
Vain NE, Satragno DS, Gorenstein AN, et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial[J]. Lancet, 2014, 384(9939): 235-240. DOI: 10.1016/S0140-6736(14)60197-5.
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