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

doi:10.3877/cma.j.issn.1673-5250.2022.01.009

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
被调查人员	被调查人数	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

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
被调查人员	被调查人数	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	—

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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