#Grand Rounds

Delayed Cord Clamping During Cesarean Delivery: Does it Result in More Maternal Blood Loss?

BACKGROUND AND PURPOSE:

Most cord clamping studies done in low-risk vaginal deliveries
Concern that delaying cord clamping could result in additional maternal blood loss
Purisch et al. (JAMA, 2019) compared maternal blood loss after immediate cord clamping vs delayed cord clamping during scheduled cesarean deliveries

Randomized clinical trial (RCT)
Participants
- Scheduled cesarean | term (≥37 weeks) | Singleton
Intervention
- Immediate cord clamping group: Clamping within 15 seconds
- Delayed cord clamping group: cord clamping at 60 seconds
Primary outcome
- Change in maternal hemoglobin level from preoperative to postoperative day 1
Secondary outcomes
- Multiple secondary outcomes assessed, including neonatal hemoglobin levels at 24 to 72 hours, umbilical cord venous hemoglobin, Apgar scores time of first cry, umbilical cord gases, etc. birthweights and additional neonatal outcomes

113 women
- Immediate cord clamping group: 56
- Delayed cord clamping group: 57
Primary outcome: No significant difference between groups for mean hemoglobin change
- Delayed group: −1.90 g/dL (95% CI, −2.14 to −1.66)
- Immediate group: −1.78 g/dL (95% CI, −2.03 to −1.54)
- Mean difference: 0.12 g/dL (95% CI, −0.22 to 0.46; P = 0.49)
Secondary outcomes: The mean neonatal hemoglobin level, was significantly higher with delayed compared to immediate clamping
- Delayed group: 18.1 g/dL (95% CI, 17.4 to 18.8)
- Immediate group: 16.4 g/dL (95% CI, 15.9 to 17.0)
- Mean difference, 1.67 g/dL (95% CI, 0.75 to 2.59; P < 0.001)

Delayed cord clamping did not result in increased maternal blood loss, based on hemoglobin levels, at the time of cesarean delivery

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