延迟断脐对分娩结局的影响

Effect of delayed cord clamping on outcome of delivery

目的探讨不同断脐时间对母儿结局的影响。方法选取2015年6月~2015年10月郑州大学第三附属医院单胎顺产的520例产妇,包括足月分娩460例和早产60例。早断脐组出生后5~10 s内断脐;晚断脐组在脐带停止搏动后断脐。比较两组新生儿评分、胆红素峰值、脐血及24 h后血红蛋白、新生儿并发症、产后出血、第三产程时间及胎盘粘连及剥离不全发生率。结果晚断脐组新生儿24 h后血红蛋白值及胆红素峰值均明显高于早断脐组(P<0.05);晚断脐组早产儿脑室内出血发生率、新生儿贫血发生率、产后出血量、第三产程时间均明显低于早断脐组(P<0.05);其余指标相比差异无统计学意义。结论晚断脐比早断脐更能增加新生儿血红蛋白,减少新生儿贫血及早产儿脑室内出血发生率且不增加新生儿并发症发生,更能减少产后出血量,缩短第三产程时间。晚断脐操作简单易行,安全有效,对母儿不会产生不良影响,值得临床推广。

Obiective To study the effect of time of clamping umbilical cord on outcome of mothers and newborns. Methods 520 cases of pregnant women in June 2015 -October 2015 in the Third Affiliated Hospital of Zhengzhou University single fetus delivery as the research object, including 460 cases of full-term and 60 cases of preterm delivery. The umbilical cord was cut off 5 to 10 seconds after the birth of the early cord clamping group. Delayed cord clamping group was adopted to late umbilical. Apgar score, the highest bilirubin after birth, hemoglobin in newborn cord blood and after 24 h hemoglobin level, neonatal complications, the bleeding volume, third labor time and the incidence of placental adhesion and peeling in two gaoups were compared. Results The highest bilirubin after birth and after 24 h hemoglobin level in delayed cord clamping group were significantly higher than early cord clamping group （P〈0.05）. The incidence of intraventricular hemorrhage in preterm infants, neonatal anemia, bleeding volume, and third labor time in delayed cord clamping group were significantly lower than early cord clamping group （P〈0.05）. The rest of index was not statistically different. Conclusions Delayed cord clamping can increase hemoglobin of newborn more than early cord clamping, reduce neonatal anemia and intraventricular hemorrhage in preterm infants and did not increase the incidence of neonatal complications, further reduce the amount of postpartum hemorrhage, shorten the time of third stage of labor. The operation is simple, safe and effective, and has no adverse effect on the mother and child, which is worthy of clinical promotion.