ACOG Committee Opinion on Delayed Cord Clamping

SUMMARY:

For both ‘vigorous’ term and preterm infants, ACOG recommends waiting at least 30 to 60 seconds after birth before 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

  • Term infants
    • Increased hemoglobin levels and iron stores
  • Preterm infants
    • Improved transitional circulation
    • Better establishment of RBC volume
    • Decreased blood transfusion
    • Lower risk of NEC and IVH

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

Immediate Umbilical Cord Clamping

When is delayed cord clamping not appropriate?

  • Maternal reasons
    • Hemorrhage
    • Hemodynamic instability
    • Abnormal placentation (e.g., previa, abruption etc.)
  • Fetal / Neonatal reasons
    • Need for immediate resuscitation
    • Placental circulation not intact
      • abruption
      • previa
      • cord avulsion
      • IUGR with abnormal cord Doppler

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

Cord Milking

  • Based on the latest evidence (see ‘Learn More – Primary Sources’ below) that found a higher risk of IVH in preterm infants (23 to 27 weeks) following cord milking, ACOG states

…cord milking should not be used for extremely preterm infants (less than 28 weeks of gestation)

…there is insufficient evidence to either support or refute umbilical cord milking in infants born at 32 weeks of gestation or more, including term infants

Learn More – Primary Sources:

ACOG Committee Opinion 814: Delayed Umbilical Cord Clamping After Birth