Introduction of newer strategies for the highest implementation of delayed umbilical cord clamping after caesarean birth – A quality improvement study

Abstract

Introduction: Delayed cord clamping (DCC) is a cost-effective delivery room intervention for better neonatal outcome. The study objective was to implement the standard practice of DCC in at least 80% of eligible neonates born by caesarean section (CS) within 2 months through multiple Plan-Do-Study-Act (PDSA) cycles. Methods: All vigorous neonates born through CS were eligible for clamping of cord ≥ 30 seconds (DCC) after birth except neonates with Rh isoimmunisation, congenital malformations, intra-uterine growth restricted fetuses with abnormal Doppler, placenta previa, abruptio placentae, cord avulsion and monochorionic-monoamniotic twins. Baseline practice of DCC in CS was observed and possible barriers elicited by fishbone analysis. Quality improvement (QI) team implemented various strategies (scientific knowledge dissemination, pre-operative planning for DCC, preventive measures for hypothermia in preterms, “cord clamp clock” in operation theatre, etc.) through a series of PDSA cycles. Timing of cord clamping (CC) was noted by a dedicated staff nurse with stopwatch. Result: Out of 112 caesarean deliveries conducted during the implementation phase, 48 and 36 deliveries were eligible for DCC during the first (PDSA-1) and the second (PDSA-2) cycle, respectively. During PDSA-1, DCC rate increased from baseline of 20% to 77% which further improved to 83.3% in PDSA-2 and 100% in the sustenance phase. The mean (SD) duration of CC during baseline, PDSA-1, PDSA-2 and sustenance phase were 13.7 (± 9.3), 30 (± 9.4), 35.2 (± 14.2), 46.6 (± 13.9) seconds, respectively. Conclusion: Implementation of best practice of DCC is challenging and needs multidisciplinary approach. Maintaining high compliance rate of DCC demands boosting confidence among perinatal team members and continued evaluation at regular intervals.

Keywords

• delayed cord clamping
• caesarean section
• neonates
• placental transfusion
• resuscitation