新生儿延迟断脐对母婴结局的影响研究

Effects of delayed umbilical cord clamping on maternal and neonatal outcomes

目的探讨延迟结扎脐带对母婴结局的影响。方法选取2016年10月—2017年6月在北京市3所医院分娩的320例产妇及新生儿作为研究对象,随机分组。实验组新生儿娩出后,待脐带搏动停止后结扎脐带;对照组新生儿娩出后60 s内立即断脐。比较两组母婴结局相关指标。结果共303例产妇和新生儿完成研究,实验组145例,对照组158例。实验组断脐时间为61~322 s,对照组断脐时间为2~60 s,两组比较,差异具有统计学意义(P<0.01)。两组新生儿出生即刻血红蛋白值、出生后5~7 d血红蛋白值差异有统计学意义(P<0.05)。两组新生儿出生后5~7 d经皮胆红素值、5~7 d黄疸发生率、蓝光治疗情况、出生后3个月贫血发生率、出生后3个月纯母乳喂养率,产妇产后出血、严重产后出血、第三产程时间差异无统计学意义(P>0.05)。结论延迟结扎脐带可以提高新生儿出生即刻、出生后5~7 d的血红蛋白值,不会增加产妇产后出血,延迟断脐与新生儿黄疸之间的关系仍需进一步研究。

Objective To determine the effects of delayed umbilical cord clamping on the postpartum hemor- rhage,instant and long-term newborn anemia,newborn jaundice. Methods In total,303 infants were selected during October 2016 to June 2017 in three hospitals in Beijing. They were randomly allocated into two groups receiving instant clamping of umbilical cord （less than 60s after delivery,n=158） and delayed clamping of umbilical cord（af- ter cord pulsation ceased,n--145）. Relevant indicators of maternal and neonatal outcomes are compared. Results There were significant differences between two groups in instant hemoglobin concentration and in 5-7 days （P〈 0.05）. There were no differences between two groups in transeutaneous bilirubin,the risk of anemia in three months,the risk of jaundice in 5-7 days and the need of blue-light therapy （P〉0.05）.There were no differences be- tween two groups of women in postpartum hemorrhage,the length of third stage of labor and the rate of breast feeding （P〉0.05）. Conclusion Clamping the mnbilical cord when cord pulsation has ceased does not have negative effects on delivery process and postpartum hemorrhage,but it increases the instant hemoglobin concentration and hemoglobin concentration after delivery in 5-7 days. Still it is unclear whether it will affect the risk of jaundice.