Obstetric Quality and Safety
Poster Session 3
Angela R. Seasely, MD, MS
Fellow
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States
Yuanfan Ye, PhD
Statistician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States
Christianna Tu, MD, MPH
Resident Physician
University of Alabama at Birmingham
Birmingham, AL, United States
Deepti Sharma, MD
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States
Colm P. Travers, MD
Assistant Professor
University of Alabama at Birmingham
Birmingham, AL, United States
Akila Subramaniam, MD, MPH (she/her/hers)
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, AL, United States
Despite ACOG’s recommendations in 2012, the implementation of delayed umbilical cord clamping (DCC) in term infants for at least 30-60 seconds as opposed to immediate cord clamping (ICC) < 30 seconds has not been universally adopted by providers. We sought to improve provider compliance with DCC among vigorous term infants.
Study Design: Prospective cohort quality improvement study completed in two phases involving vigorous term infants (≥ 37 weeks). Patients with suspected placenta accreta spectrum and twin gestations were excluded. Pre-intervention data were collected from 4/1/2022-9/30/2022. Phase 1 was conducted from 10/1/2022-2/28/2023 and included implementing DCC of 30-60 seconds. Phase 2 was conducted from 3/1/2023-5/31/2023 and included implementing DCC of >60 seconds. We provided monthly education for providers and a multidisciplinary team reviewed outcomes and process measure data throughout the study. Our SMART aim was to decrease the relative rate of ICC of term infants by 75%. Our global aim was to decrease rates of NICU admission and unexpected need for pediatric providers at delivery. Mitigating maternal and neonatal factors that may deter providers from performing DCC were tracked. Comparisons between categorical and continuous variables were made with Chi-squared, ANOVA, and exact test as appropriate.
Results: Of the 3303 term singleton deliveries during the study period, 282 infants were excluded due to non-vigorous status at delivery (8.4% pre-intervention, 9.0% Phase 1, 8.0% Phase 2, p=0.7). Thus, a total of 3021 patients were included in the analysis. No differences were seen in baseline characteristics (age, race, insurance status, mode of delivery, type of anesthesia) across the study period. The rate of ICC decreased by 91% from the baseline rate over 8 months (74.6% pre versus to 6.6% post). Maternal and neonatal outcome did not differ over the study period (Table).
Conclusion: We successfully implemented delayed cord clamping in vigorous term infants through a quality improvement initiative focused on provider education. The rate of ICC was decreased from baseline by 91%.