延迟结扎脐带对母儿围产期结局的影响

目的:比较不同时间延迟结扎脐带对母体产后出血及新生儿一周内的贫血率和黄疸发生率的影响。方法:收集我院2016年02月~2016年12月共663例正常单胎顺产产妇并进行随机分组,其中A组138例10 s内立即结扎脐带、B组128例延迟至30 s结扎脐带、C组133例延迟至1 min结扎脐带、D组117例延迟至脐动脉停止搏动时结扎脐带和E组147例延迟至胎盘娩出后结扎脐带,比较以上五组新生儿贫血和黄疸发生率及产妇产后出血情况。结果:五组新生儿脐带血、1-2 d足跟血的贫血发生率比较差异具有统计学意义(P=0.015,P=0.046),均以D组最低。五组新生儿6-8 d足跟血的贫血发生率比较以D组贫血发生率最低,但差异无统计学意义(P=0.778)。五组新生儿出生后1-2 d、6-8 d的黄疸发生率比较差异均无统计学意义(P=0.093,P=0.335)。五组产妇的产后出血量比较差异具有统计学意义(P=0.017),以D组效果最好。结论:延迟结扎脐带在降低新生儿贫血发生率的同时并没有增加新生儿的黄疸发生率,并且降低了产妇产后出血量,尤其是当脐动脉停止搏动后结扎脐带可显著减少新生儿贫血的发生率以及产妇的产后出血量。

Effects of Delayed Cord Clamping on the Outcomes of Neonates and Maternal during Perinatal Period

ABSTRACT Objective: To compare the impacts of delayed cord clamping (DCC) on the maternal postpartum hemorrhage and the incidence of anemia and jaundice for vaginal birth infants during the first week. Methods: According to the including criteria, the present study enrolled 663 puerperas with single fetus and natural delivery in our single center from February to December 2016. The random number table was generated through SPSS software, based on which the participants were randomized to 5 groups: Group A consisted of 138 participants with immediate cord clamping; group B consisted of 128 participants with cord clamping delayed to 30s; group C con- sisted of 133 participants with cord clamping delayed to 1min; group D consisted of 117 participants with cord clamping after umbilical artery stopped beating; group E consisted of 147 participants with cord clamping after placental expulsion. Results: There existed signifi- cant difference regarding the incidence of anemia among the five groups of the neonatal cord blood (P=0.015) and 1-2 day heel blood (P=0.046), and those of group D reached the lowest. According to the assessments of 6-8 day heel blood, the incidence of anemia for group D was lower than those of the other groups; however, there was no significant difference (P=0.778). Besides, there was no signifi- cant difference in the incidence of jaundice between the five groups at both 1-2 day (P=0.093) and 6-8 day (P=0.335) after birth. The dif- ference of postpartum hemorrhage between the five groups was statistically significant (P=0.017), and the effect of group D was the best. Conclusion: DCC decreased the incidence of anemia without increasing the incidence of jaundice for newborn and decreased the vol- ume of postpartum hemorrhage for puerperas; the time of umbilical artery stopped beating might be the optimal point for cord clamping.