Head-to-body delivery by “two-step” approach: effect on cord blood hematocrit

Abstract Background: There is no study to support a relationship between placental transfusion and active management techniques of the second stage of labor. Objective: To examine the association between head-to-body delivery by a “two-step” approach (which includes waiting for the next contraction to deliver the shoulders) and its effect on the amount of blood that remains in the infant’s circulation at birth. Study design: Observational study on 500 consecutive, singleton, and at term deliveries from January to June 2012 in Policlinico Abano Terme, Abano Terme, Italy. Umbilical artery hematocrit (Htc) was evaluated in reference to contemporary tested pH values, involving neonates vaginally delivered by the “two-step” approach and by cesarean section, respectively. Results: Head-to-body delivery by the “two-step” approach significantly increased Htc values with respect to cesarean delivery (50.16% versus 47.24%, p < 0.001) and at the same time reduced pH (7.31 ± 0.09 versus 7.33 ± 0.06, p = 0.007) in umbilical artery. In addition, Htc levels for this group were significantly negatively correlated with umbilical artery pH (r = −0.137, p < 0.018). Conclusion: Head-to-body delivery by the “two-step” approach increases the red cell mass in term infants without any clinical risk of neonatal acidemia.

[1]  P. Middleton,et al.  Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. , 2013, The Cochrane database of systematic reviews.

[2]  A. Longoni,et al.  Head-to-body delivery interval using ‘two-step’ approach in vaginal deliveries: effect on umbilical artery pH , 2011, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[3]  D. Elbourne,et al.  WITHDRAWN: Active versus expectant management in the third stage of labour. , 2009, The Cochrane database of systematic reviews.

[4]  K. Källén,et al.  Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations , 2008, BJOG : an international journal of obstetrics and gynaecology.

[5]  J. Langhoff‐Roos,et al.  Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe , 2007, BJOG : an international journal of obstetrics and gynaecology.

[6]  E. Hutton,et al.  Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. , 2007, JAMA.

[7]  L. Neufeld,et al.  Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial , 2006, The Lancet.

[8]  P. V. van Rheenen,et al.  Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial , 2006, Pediatrics.

[9]  C. Spong,et al.  A Randomized Controlled Trial of Prophylactic Maneuvers to Reduce Head‐to‐Body Delivery Time in Patients at Risk for Shoulder Dystocia , 2003, Obstetrics and gynecology.

[10]  M. McNabb,et al.  A six-year retrospective analysis of shoulder dystocia and delivery of the shoulders. , 1998, Midwifery.

[11]  R. Pérez‐Escamilla,et al.  Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. , 1997, The American journal of clinical nutrition.

[12]  A. Pisacane.  Neonatal prevention ofiron deficiency , 1996, BMJ.

[13]  K. Michaelsen,et al.  A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors , 1995, Acta paediatrica.

[14]  F. Piquard,et al.  Are There Two Biological Parts in the Second Stage of Labor? , 1989, Acta obstetricia et gynecologica Scandinavica.

[15]  V. Black.  Neonatal hyperviscosity syndromes. , 1987, Current problems in pediatrics.

[16]  C. Wood,et al.  TIME—AN IMPORTANT VARIABLE IN NORMAL DELIVERY , 1973, The Journal of obstetrics and gynaecology of the British Commonwealth.

[17]  G. Bush.  Foetal and Neonatal Physiology: a comparative study of the changes at birth , 1969 .

[18]  R. Lawrence.  Foetal and Neonatal Physiology: A Comparative Study of the Changes at Birth , 1968 .

[19]  J. Lind,et al.  Placental transfusion-rate and uterine contraction. , 1968, Lancet.

[20]  V. Hampl,et al.  Regulation of fetoplacental vascular bed by hypoxia. , 2009, Physiological research.

[21]  J. Fuente.  Neonatal hematology , 2007, Bone Marrow Transplantation.

[22]  J. Apuzzio,et al.  A randomized controlled trial of prophylactic maneuvers to reduce head-to-body delivery time in patients at risk for shoulder dystocia. , 2003, Obstetrics and gynecology.

[23]  G. Hart.  Waiting for shoulders. , 1997, Midwifery today and childbirth education.

[24]  H. Kaminetzky,et al.  Principles and practice of obstetrics & perinatology , 1981 .

[25]  R. Phibbs,et al.  Cesarean section prevents placenta-to-infant transfusion despite delayed cord clamping. , 1975, American journal of obstetrics and gynecology.