Evidence-Based. Clearly Delivered.
Evidence-Based. Clearly Delivered.
For both ‘vigorous’ term and preterm infants, ACOG recommends waiting at delayed clamping the umbilical cord. The committee opinion provides a comprehensive literature and evidence review. ACOG states
In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes
Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage
Benefits include
Note: There was no evidence for increased risk of PPH
Caution: The committee opinion notes that there may be a small risk for jaundice requiring phototherapy in term infants and therefore the delivery center should have the necessary infrastructure to monitor and treat, if necessary
When is delayed cord clamping not appropriate?
NOTE: ACOG states
Maternal hemodynamic instability or the need for immediate resuscitation of the newborn on the warmer would be an indication for immediate umbilical cord clamping
In preterm neonates born at 28 0/7–36 6/7 weeks of gestation who do not receive deferred cord clamping, umbilical cord milking is a reasonable alternative to immediate cord clamping to improve neonatal hematologic outcomes
ACOG Committee Opinion 814: Delayed Umbilical Cord Clamping After Birth
ACOG Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates
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