Collection of umbilical cord blood and the risk of complications in postpartum women after natural labour in the context of the possibility of umbilical cord stem cells usage in clinical practice

Abstract

Objectives: Comparison of changes in peripheral blood venous morphology and the frequency of select complications in patients who underwent umbilical cord blood collection during the third stage of labour by in the utero method compared to patients who did not undergo this procedure. Presentation of current therapeutic possibilities of cord blood stem cells. Material and methods: The study involved 248 patients who had a vaginal delivery and had umbilical cord blood taken by in utero method during the third stage of labour. The control group consisted of the first 400 patients who gave vaginal delivery starting in 2019. Each patient had a venous peripheral blood count taken before delivery and 18 hours after delivery. Changes in the results of laboratory tests and the occurrence of adverse outcomes, such as postpartum curettage, postpartum haemorrhage and manual removal of placenta, in the 3 rd and 4 th stage delivery periods, were analysed. Results: In the blood donor group there were significantly lower haemoglobin (11.32 g/L vs 11.61 g/L, p = 0.004) and haematocrit (32.83% vs 33.82% p = 0.001) concentrations after delivery. Umbilical cord donors had a greater difference in haemoglobin (postpartum minus prepartum) (-1.4 g/L vs-0.9 g/L, p = 000), and haematocrit (-4.05% vs-2.5% , p = 0.000). The study group had a higher percentage of patients with postpartum anaemia (haemoglobin concentration < 10 g/L) (15.9% vs 10.64%, p = 0.05), but the result were borderline significant. The groups did not differ in terms of the percentage of postpartum curettage, PPH, manual removal of placenta, percentage of severe anaemia (Hb < 7g/L) or transfusion requirement. Conclusion: Collection of umbilical cord blood during the 3 rd stage of labour using the in utero method is associated with a statistically significant increase of blood loss and a higher probability of postpartum anaemia. The observed changes are minor and may have little clinical significance in otherwise healthy patients.

The effect of collecting umbilical cord blood during caesarean section on perioperative blood loss and incidence of complications

“…However, the differences in the reduction of hemoglobin and hematocrit were small and clinically insignificant in young, otherwise healthy women (the decrease in Hb was 1.4 g/dl in the study group vs. 0.9 g/l in the control group, p < 0.001). No differences were found in the rates of maternal complications such as the percentage of patients with postpartum hemorrhage, postpartum curettage, manual removal of placenta, percentage of severe anemia (Hb < 7 g/l), or blood transfusion requirement [2].…”

“…Still, scientific evidence does not justify the routine recommendation of private banking in obstetric practice, as reflected in the recommendations of the American College of Obstetricians and Gynecologists [1]. Meanwhile, in numerous countries, we are faced with relentless marketing of cord blood banking companies, which overestimate the current potential of umbilical cord blood use while lacking objective evidence of benefit in many of the advertised clinical indications [2,6]. Considering the above, first of all, due diligence should be applied to comply with the standards of perinatal care and to appropriately apply procedures with a documented positive impact on the child's development (such as DCC) [7,8].…”

“…Firstly, CBU collection by "in utero" (collection before delivery of placenta) method may prolong time from neonate delivery to the beginning of suturing the uterine muscle. Secondly, there are data in the literature indicating a small but statistically significant blood loss in the case of vaginal delivery and CBU collection [2,3].…”

Study on umbilical cord shedding time and influencing factors of premature infants

“…Due to low gestational age, low body weight, thinner cortex, less subcutaneous fat and other reasons, premature infants are at higher risk of umbilical infection [17]. Previous clinical studies [18,19] have clarified the time and influencing factors of cord shedding in full-term newborns, but there are still no clinical reports on the time and influencing factors of cord shedding in premature infants. It is of great significance to identify the time and influencing factors of umbilical cord shedding in premature infants to prevent adverse events such as umbilical cord infection and improve the prognosis of premature infants.…”

The relevance of blood gases levels in newborns: the sampling matters

“…To avoid bias caused by further metabolic changes after birth, arterial and venous sam-ples should preferably be taken from a double-end clamped piece of the umbilical cord [3,4]. Nevertheless, the method of umbilical cord sampling for other purposes, including stem cells acquisition or blood group phenotyping for the neonatal risk assessment, requires further investigation [5,6].…”