Implementation of Delayed Cord Clamping in a Tertiary care Hospital: A Quality Improvement Project

Abstract

Introduction: Delayed cord clamping (DCC) is defined as the delay in the clamping of the umbilical cord for more than 60 seconds or when the umbilical cord pulsations have stopped. It has numerous benefits to the infants like increased circulating volume, increased hemoglobin / haematocrit levels, elevated iron stores, and decreased need for red blood cell transfusions. Despite evidence-based recommendation, delayed cord clamping is not practiced routine in some medical settings.

Methods: This quality improvement project (QI Project) was conducted to implement delayed cord clamping in one of the tertiary care hospital through Plan-Do-Study-Act (PDSA) cycles. We wanted to improve practice of delayed cord clamping from baseline to 70% in babies delivered by Cesarean section in a tertiary care hospital at Lalitpur. We included term and preterm vigorous newborns delivered by uncomplicated lower segment cesarean section (LSCS). After orientation to the Department of Paediatrics and Obstetrics, project was carried out between August 2021 to October 2021. Data was compiled every two weeks and obstacles and shortcomings were discussed and multiple interventions were done accordingly.

Results: Out of 916 deliveries via LSCS, after exclusion 805 eligible cases were assessed in three months. The percentage of Delayed cord clamping (DCC) among uncomplicated LSCS increased to 70% in the month of October.

Conclusions: QI project was helpful in improving the compliance of Delayed cord clamping (DCC) in the clinical practice by addressing the problems encountered among the study population.