Delayed cord clamping does not affect umbilical cord blood gas analysis



Although delayed umbilical cord clamping has been shown to have significant benefits for both term and preterm infants, currently, data on its impact on blood gas analysis have been scant and conflicting.


In a retrospective review, we compared the demographic characteristics and blood gas parameters of 114 delayed cord clamping (DCC—births between 45 and 90 s in length; 109 being for 60 s) versus 407 early cord clamping births (ECC—immediately after delivery) collected over a 1-year period. Intrapartum care and timing of cord clamping for individual cases were performed at the discretion of obstetricians. The differences were assessed for statistical and clinical significance.


The DCC group was found to have significantly higher mean Apgar scores at both 1 and 5 min (p < 0.05), as well as lower percentages of nulliparous births, cesarean-section deliveries, epidural anesthesia usage, and major pregnancy-related complications. No significant differences in maternal age, gestational age, neonate birthweight, sex, or in the presence of meconium at birth were observed. A higher umbilical artery pO2 in the DCC group [21 (9) vs. 19 (10) mmHg, p < 0.05] was the only statistically significant difference found out of all the blood gas parameters analyzed.


In this study, infants selected for the DCC procedure were found to be overall lower risk than those delivered as per the standard ECC procedure. No clinically significant difference in any blood gas parameter was observed, and therefore, no adjustment to clinical reference intervals is needed for DCC blood gas samples taken after a 1-min delay period.

This is a preview of subscription content, log in to check access.


  1. 1.

    Nicolaides KH (2016) Committee opinion. Obstet 128(654):1–4.

    Article  Google Scholar 

  2. 2.

    Linderkamp O, Nelle M, Kraus M, Zilow EP (1992) The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr 81(10):745–750. Accessed 1 Aug 2018

  3. 3.

    McDonald SJ, Middleton P, Dowswell T, Morris PS (2013) Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 7:CD004074.

    Article  Google Scholar 

  4. 4.

    Hutton EK, Hassan ES (2007) Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 297(11):1241–1252.

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Lawton C, Acosta S, Watson N et al (2015) Enhancing endogenous stem cells in the newborn via delayed umbilical cord clamping. Neural Regen Res. 10(9):1359.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Sanberg PR, Divers R, Mehindru A, Mehindru A, Borlongan CV (2014) Delayed umbilical cord blood clamping: first line of defense against neonatal and age-related disorders. Wulfenia 21(6):243–249. Accessed 1 Aug 2018

  7. 7.

    Rabe H, Diaz-Rossello JL, Duley L, Dowswell T (2012) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 8:CD003248.

    Article  Google Scholar 

  8. 8.

    Bhatt S, Alison BJ, Wallace EM et al (2013) Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 591(8):2113–2126.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Chopra A, Thakur A, Garg P, Kler N, Gujral K (2018) Early versus delayed cord clamping in small for gestational age infants and iron stores at 3 months of age - a randomized controlled trial. BMC Pediatr 18(1):234.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Tarnow-Mordi W, Morris J, Kirby A et al (2017) Delayed versus immediate cord clamping in preterm infants. N Engl J Med 377(25):2445–2455.

    Article  PubMed  Google Scholar 

  11. 11.

    MacLennan A (1999) A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ 319(7216):1054–1059. Accessed 28 June 2018

  12. 12.

    D’Alton ME, Hankins GDV, Berkowitz RL, Bienstock J, Ghidini A, Goldsmith J, Higgins R, Moore TR, Natale R, Nelson KB, Papile L-A, Peebles D, Romero RJ, Schendel D, Spong CY, Waldman RN, Yvonne W, Joseph GF Jr, Hawks D, Politzer A, Emig C, Thomas K (2014) Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Report of the American college of obstetricians and gynecologists’ task force on neonatal encephalopathy. Obstet Gynecol 123(4):896–901.

    Article  Google Scholar 

  13. 13.

    Wiberg N, Källén K, Olofsson P (2008) Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG An Int J Obstet Gynaecol 115(6):697–703.

    Article  CAS  Google Scholar 

  14. 14.

    De Paco C, Florido J, Garrido MC, Prados S, Navarrete L (2011) Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Arch Gynecol Obstet 283(5):1011–1014.

    Article  PubMed  Google Scholar 

  15. 15.

    Valero J, Desantes D, Perales-Puchalt A, Rubio J, Diago Almela VJ, Perales A (2012) Effect of delayed umbilical cord clamping on blood gas analysis. Eur J Obstet Gynecol Reprod Biol 162(1):21–23.

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Armstrong RA (2014) When to use the Bonferroni correction. Ophthalm Physiol Opt 34(5):502–508.

    Article  Google Scholar 

  17. 17.

    Alamolhoda M, Ayatollahi SMT, Bagheri Z (2017) A comparative study of the impacts of unbalanced sample sizes on the four synthesized methods of meta-analytic structural equation modeling. BMC Res Notes 10(1):446.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Yan R, Lou A, Watts G et al (2014) Comparison of Becton Dickinson Vacutainer rapid serum tube with the serum separator tube for routine chemistry and immunoassay tests. J Clin Pathol 67(7):599–604.

    Article  PubMed  Google Scholar 

  19. 19.

    Chen J, Gorman M, O’Reilly B, Chen Y (2016) Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients. Clin Biochem 49(9):708–712.

    Article  PubMed  Google Scholar 

  20. 20.

    Pupek A, Matthewson B, Whitman E, Fullarton R, Chen Y (2017) Comparison of pneumatic tube system with manual transport for routine chemistry, hematology, coagulation and blood gas tests. Clin Chem Lab Med 55(10):1537–1544.

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Skovlund E, Fenstad GU (2001) Should we always choose a nonparametric test when comparing two apparently nonnormal distributions? J Clin Epidemiol 54(1):86–92. Accessed 11 Sept 2018

Download references

Author information




YC and S-LS contributed to the conception of the project. JT and RF collected data. JT and YC did data analysis and drafted the original manuscript. YC, S-LS, and RF critically revised the manuscript for intellectual content. All of the authors approved the final version to be published and agreed to act as guarantors of the work.

Corresponding author

Correspondence to Yu Chen.

Ethics declarations

Conflict of interest

No potential conflict of interest relevant to this manuscript was reported.

Ethical standards

All DCC and ECC cases of vigorous term and preterm infants between February 2017 and February 2018 were retrospectively reviewed with a study protocol approved by the Institute Research Ethics Board (File #: 2018-2614). Maternal and neonatal demographic variables including maternal and gestational age, parity, mode of delivery, epidural anesthesia usage, neonate birthweight, Apgar scores at 1 and 5 min, sex, presence of meconium at birth, and major pregnancy-related complications (including gestational diabetes mellitus, chorioamnionitis, and cholestasis, etc.), were pulled from medical records and compared.

Informed consent

Informed consent was waived with the approval of the Research Ethics Board of Horizon Health Network.

Human and animal rights statement

This article does not contain any studies with animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tang, J., Fullarton, R., Samson, S. et al. Delayed cord clamping does not affect umbilical cord blood gas analysis. Arch Gynecol Obstet 299, 719–724 (2019).

Download citation


  • Delayed cord clamping
  • Early cord clamping
  • Blood gas
  • Neonate
  • Pregnancy