Clinical Research Directory

The Effect of Different Positions Given to the Newborn During Delayed Cord Clamping on Physiological Indicators and Comfort

During intrauterine life, the fetus is connected to the mother via the placenta; with birth, the extrauterine adaptation process begins. The first six hours after birth are defined as the "adaptation period" for the newborn and consist of three stages. In this process, the first reactive period is particularly critical because the initial assessments determine the newborn's well-being. All organs, especially the respiratory and cardiovascular systems, are rapidly activated, and adaptation parameters are monitored. Evidence-based care interventions applied by midwives during this period directly affect the newborn's physiological stability and long-term health. The timing of umbilical cord clamping is a decisive factor in this adaptation. The World Health Organization recommends waiting at least 1 minute after birth for term and stable preterm infants, ideally with a delay of 1-3 minutes for clamping. Blood flow from the placenta to the baby continues for the first few minutes after birth. Therefore, not clamping the umbilical cord until 2-3 minutes have passed or until the cord pulse has completely stopped provides a physiological blood transfer. In this process, defined as "placental transfusion," a large portion of the blood passes to the baby within the first 3 minutes, contributing to an increase in circulatory volume and hemoglobin levels. In premature infants, stem cell transfer reduces complications and provides long-term benefits. In addition, this practice increases venous return, supporting heart filling and facilitating cardiorespiratory transition. In infants who undergo delayed clamping, oxygen saturation rises faster and irregular heartbeats are less common.

Intact Cord Placental Delivery vs Delayed Cord Clamping

The management of the third stage of labour plays a critical role in neonatal transition. Uninterrupted Intact Cord Clamping (UICC), is a clinical approach where the umbilical cord remains unclamped until the placenta is spontaneously expelled. This method aims to facilitate the maximum physiological transfer of placental blood to the newborn. While Delayed Cord Clamping (DCC)-typically defined as clamping between 1 and 3 minutes or until pulsations cease-is widely supported by literature for its ability to improve neonatal iron stores and reduce morbidity and mortality without increasing maternal-foetal risk, there is currently a lack of robust evidence regarding the systematic practice of Uninterrupted Intact Cord Clamping (UICC), defined as clamping only after placental delivery. This gap in the literature necessitates a thorough investigation into the potential benefits and safety of UICC.

Delayed Versus Immediate Cord Clamping in Preterm Birth

The goal of this study is to evaluate whether delayed cord clamping improves early neonatal outcomes compared with immediate clamping in preterm birth. Preterm infants are at higher risk of neonatal complications, and the timing of cord clamping may influence placental transfusion and neonatal adaptation after birth. Delayed cord clamping may increase blood volume, improve iron stores, and reduce some neonatal morbidities, while immediate cord clamping is still commonly practiced in many settings. In this study, preterm newborns are assigned to either delayed or immediate cord clamping according to a predefined protocol. Early neonatal outcomes, including respiratory status, need for resuscitation, hemoglobin levels, and early morbidity and mortality, will be assessed. The study is conducted in a tertiary maternity center in Tunisia.

Prone Positioning During Delayed Cord Clamping

Delayed cord clamping is a routine technique used in the delivery room. The baby remains attached to the umbilical cord and placenta for 30-60 seconds after birth to allow for maximal transfer of oxygen and blood to the newborn. This study seeks to determine the best position (on the back versus on the belly) for the newborn during the 30-60 seconds of delayed cord clamping.