Faculty of Midwifery at Babol University of Medical Sciences, Iran.
Abstract
This experiment was performed in order to compare the effect of early and late cord clamping in the third stage of labor, with prevalence of retained placenta (delay in the release of placenta for 30 minutes) and hemorrhage in 230 singleton deliveries.
Gestations less than 34 weeks, newborns with low birth weight (less than 2000gms) and fetal respiratory distress and also the Rh− mothers were all excluded from the experiment.
Experimental cases were randomly classified into two groups. In one group the cord was clamped early and in the other group it was clamped late.
The group had comparable similarities in regards to the age, duration of stage 1 and 2 of labor, previous third stage abnormalities, sections, gravidity, induction of labor and method of vaginal deliveries.
The average duration of stage 3 in early cord clamp group was 6.6 minutes and in other group it was 3.6minutes which shows statistically difference (P<0.05).
Prevalence of retained placenta in the first group was seen only in one case was (0.9%) while in other group it was not seen.
In the first group the average hemorrhage was 180 ml while in the other group it was 72 ml which is statistically a significant difference (P<0.05).
On the bases of the results obtained in this research, late cord clamping is advised in order to reduce the duration of the third stage and also the amount of hemorrhage.
Introduction
The third stage of labor is the time after the birth of the baby until the placenta delivered (1). The third stage is very important time: good care helps make sure the mother doesn't bleed too heavily. Heavy bleeding is called a postpartum hemorrhage (PPH) and it is dangerous and frightening (2). Postpartum hemorrhage is the leading cause of direct maternal death in developing countries (3). It is respectively hazardous when the duration of third stage exceeds 30 minutes. Retained placentas have been reported to occur with a frequency of 1.1%, 1.5% and 3.3% of deliveries (4,5) Expectant management of third stage of labor involves allowing the placenta to deliver spontaneously or aiding by gravity or nipple stimulation. Active management involves administration of a prophylactic oxytocic before delivery of the placenta and usually early cord clamping and cutting, and controlled cord traction of the umbilical cord (6).
In many places it is custom to wait until the placenta is born before cutting the cord. When there is no problem with mother or baby (2). The objective of this study was to compare the effect of early and late cord clamping in the third stage of labor with prevalence of retained placenta (undelivered placenta in>30 minutes) and hemorrhage.
Material and Methods
This research was done on 230 single fetus case. Gestational ages less than 34 weeks, Rh- patients, abnormal delivery, and newborns with low birth weight (less than 2000grm) and fetal respiratory distress were omitted.
The groups had comparable similarities in regards to the age, duration of stage 4 and 2 of labor, previous third stage abnormalities, sections, gravidity, induction of labor and method of vaginal deliveries.
Experimental cases were randomly classified into two groups. In one group the cord was clamped early and in the other group was waited until the placenta was born then it was clamped and cut. Placement of the baby from birth until cord division was on the interoitus. Both group of patients was observed for signs of placental separation and descent, the placenta was delivered by Brandt Androw's method. The time of delivery of placenta was noted and the uterus massaged gently to ensure contraction. Patient also routinely received oxytocin after delivery of the placenta. A placenta was considered retained if not delivered by 30 minutes. The placenta was delivered by manual removal. Immediately delivery a kidney dish was taken and the blood volume from completed deliver until delivery of the placenta, was collected and noted.
Results
The average duration of separation of placenta in early cord clamp group was 4.9 minutes and in other group it was 2.2 minutes, which shows statistically significant difference. (P<0.005 duration from separation of placenta to complete delivery of placenta was similar (In first group 1.4 minutes and in the other group 1.37 minutes). Fig 1 shows duration of third stage of labor. The average duration of stage3 in the early cord clamp group was 6.6minutes and in the other group it was 3.6minutes which shows statically significant difference (P<0.05) prevalence of retained placenta in the first group only in one case was (0.9%) while in other group it was not seen.
Fig1: duration of third stage
Fig 2 shows volume hemorrhage of third stage. The average hemorrhage of third stage in the first group one was 108ml while in the second group it was 72ml while shows statistically significant difference (P<0.005).
Fig 2 : Volume of hemorrhage of third stage
Discussion
The results documented that early cord clamp is associate with longer duration of third stage of labor (6.6 minutes versus 3.6 minutes). Oxford midwives research group reported (1991) clearly established that late and early cord clamping were not effected on placenta separation (7).
Enkin (1996) reported that the duration of the third stage is reduced by the use of early cord clamping (8). The third stage of labor often is scarcely considered by parturients and birth attendants although it is thought to be the most dangerous stage of labor because of the risk of significant hemorrhage (9). In our study, amount of maternal blood loss in the third stage was reduced by the use of late cord clamping but Enkine showed the time clamping does not appear to influence the frequency of postpartum hemorrhage. Late clamping of the cord may have advantage over early clamping as it allows greater placental transfusion of the baby (10).
Moss et al (1964) shows that 75% of those clamped early had depressed Apgar score at one minute compared with 25% of clamped late (11). Late cla ??
The results documented that early cord clamping is mp increases but it not enough to raise the incidence of clinical jundice (12). Therefore necessary to teach medical students and midwives to wait until the placenta is born before cutting the cord.
Reference
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