Abstract

ABSTRACT

Introduction: In common obstetric practice, the cord is clamped soon after birth. Deferring cord clamping for 2 – 3 minutes after birth or when cord pulsations stop allows blood flow between baby and placenta to continue for a few moments. Recent research provides evidence for the beneficial effect of delayed cord clamping on infant iron status and haemoglobin levels. Iron deficiency anemia is a major public health problem in young children worldwide. The increase in neonatal blood volume seen with delayed cord clamping has the potential both to increase iron stores and hemoglobin concentrations. This study is conducted as anemia is highly prevalent among the pregnant females in Pakistan thus they are likely to reproduce children with low haemoglobin levels. Presently early cord clamping is a common practice in labour suites across Pakistan but hypothetically speaking huge benefits were anticipated from delayed clamping.
Methodology: All patients, fulfilling the inclusion and exclusion criteria were selected from Labour Room / Emergency Department of hospital. The patients were not aware of the randomization arm and were selected via lottery method. All patients underwent Spontaneous Vaginal Delivery and informed consent was taken for taking baby’s blood sample within 24 hours after birth. Delayed or early cord clamping was done according to randomization. Blood sample of the neonates was sent to a standard laboratory within 24 hours after birth for analyzing full blood counts.
Results: The average neonatal hemoglobin level in group A (delayed cord clamping) was 18.7mg/dl and range was 16.2-19.8 mg/dl but in group B (early cord clamping) average Neonatal Hb level was 17.6mg/dl and range was 16.7-19.2 mg/dl. The calculated ’t’ value is 8.290 (p = 0.000) and thus shows statistically significant difference between the two groups. Hence alternative hypothesis is accepted.
Conclusion: Our study support that delaying cord clamping >180 sec in low and middle-income countries, where iron deficiency anemia is prevalent among mothers and new borns, may be beneficial as it improves neonatal haemoglobin. Thus delayed clamping of cord should become a standard protocol in obstetrical practice due to its proven benefits over early clamping of cord.

Key words: Neonatal haemoglobin, Anemic mother, Early cord clamping, Delayed cord clamping, Spontaneous Vaginal Delivery