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Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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)

CONCLUSION:

  • 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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Learn More – Primary Sources:

Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery -A Randomized Clinical Trial

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Related ObG Topics:

ACOG Committee Opinion on Delayed Cord Clamping
Umbilical Cord Milking or Delayed Cord Clamping in Preterm Infants?
Is There Benefit to 3 Minute Delay in Umbilical Cord Clamping?
A Quantitative Method to Better Estimate of Blood Loss During Cesarean

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