Aim. The aim of this study is to analyze the umbilical cord blood (UCB) collection over 2 years between October 2008 and September 2010 in our UCB Collection Centre, seeking to assess how some clinical and obstetric factors could influence the number of banked UCB units. Material and methods. We recruited couples at 35 weeks of gestation, that were asked to give informed consent for UCB donation, after proper counselling and accurate history taking for both parents, focusing on genetic, immunological and infectious diseases. The UCB collection was performed daily, at the time of delivery in the case of both vaginal delivery and Caesarean section, between 37 and 41+6 weeks of gestation, between October 2008 and September 2010, in the Obstetrics department of our hospital ('Di Venere' Hospital, Bari). 'In utero' collection was the preferred method, with cord clamping time more than 1 minute after birth. UCB units were accepted for cryopreservation by our local UCB bank (Puglia UCB Bank, PUCBB), if the Total Nucleated Cells (TNC) content was >80×10 7. Statistical analysis was performed using Pearson correlation coefficient, Student's t-test, Mann-Whitney test and κ2 test. Results. During the 2 years study period, we had 2971 deliveries in our hospital. The patients that opted for UCB donation were 1117, 37.6%. We excluded 244 patients at the time of recruitment and 160 UCB units at the time of delivery, according to obstetric (feto-maternal) exclusion criteria. We therefore sent to the PUCBB 713 units, 24% of the total number of deliveries. The UCB bank discarded 445 units due to low content of nucleated cells, and 62 due to other clinical and technical reasons. The UCB units discarded before cryopreservation were therefore 507. There were also 22 UCB units discarded after cryopreservation because of either maternal or neonatal issues. The total number of discarded UCB units was therefore 529, that means 74.2% out of 713 sent to the UCB bank with just 184 UCB units finally accepted for cryopreservation, that means the remaining 25.8%. The statistical analysis (Pearson correlation coefficient) shows that the neonatal weight correlates positively with the weeks of gestation at delivery (r=0.304; p=0.000), with the collected UCB unit volume (r=0.191; p=0.000), with the Total Nucleated Cells (TNC) (r=0.252; p=0.000) and CD34+ collected (r=0.222; p=0.001). The UCB unit volume correlates positively with the CD34+ collected (r=0.433; p=0.000). Maternal age negatively correlates with the weeks of gestation (r=0.155; p=0.000). Primiparas are significantly younger, have longer labour and gestation. The TNC number collected from this subgroup is higher than in pluriparas, and the mean difference between the two groups is 100×10 6. Primiparas have higher concentration of TNC per volume unit as well. In this subgroup the TNC number collected after spontaneous vaginal deliveries is significantly bigger than after cesarean section (2,81×103/ul TNC and average 190×106 of TNC more), even if the UCB volume collected after cesarean section is bigger than after vaginal delivery. Discussion. Considering the new requirements to allow cryopreservation (UCB unit containing more than 1.2×109), we searched for the features of UCB donors able to produce UCB units containing more than 1.2×109 TNC (18.4% of the UCB units collected during the study period). This group of donors is composed as follows: 68.5% primiparas and 31.5% pluriparas; 89.3% neonates with birthweight >3000 gr and just 10.7% birthweight 9 TNC. Ideally the mother should be primipara (more likely to have a good TNC content), and deliver at 37-40 weeks; important obstetric factors would be birthweight >3000 gr, short clamping time (within 30 seconds), 'in utero' collection method. Spontaneous vaginal delivery should be preferred to cesarean section, as usually correlated to longer labour (increased fetal stress).
|Translated title of the contribution||Impact of the obstetric factors on the umbilical cord blood donation: A two-year experience|
|Number of pages||8|
|Journal||Giornale Italiano di Ostetricia e Ginecologia|
|Publication status||Published - Jul 2012|
ASJC Scopus subject areas
- Obstetrics and Gynaecology