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Effects of cord clamping timing in at-term elective cesarean section on maternal and neonatal outcomes: a randomized trial

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to compare the effects of early cord clamping (ECC), delayed cord clamping (DCC), and umbilical cord milking (MC) on maternal and neonatal outcomes in elective cesarean births.

Methods

We analyzed 204 women with uncomplicated at-term singleton pregnancies, who underwent cesarean birth under regional anesthesia between March and July 2021. The women were randomized into three groups: DCC (clamped 60 s postpartum), ECC (clamped within 15 s postpartum), or MC (clamped after milking five times) group. The neonatal and maternal outcomes of the groups were evaluated.

Results

The duration of the operation was significantly lower (P < 0.001) in the MC group at 50 min (ECC, 60 min; DCC, 60 min), while intraoperative bleeding was significantly higher (P < 0.001) in the ECC group at 500 mL (DCC, 300 mL; MC, 225 mL). The rates of anemia and polycythemia significantly differed (P = 0.049) between the three groups. DCC and MC did not negatively affect maternal and neonatal outcomes compared with ECC.

Conclusion

DCC and MC are superior to ECC in terms of short-term maternal and neonatal outcomes in cases of elective cesarean birth under regional anesthesia.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request until 5 years after publication.

References

  1. Delbaere I, Cammu H, Martens E, Tency I, Martens G, Temmerman M (2012) Limiting the cesarean section rate in low risk pregnancies is key to lowering the trend of increased abdominal deliveries: an observational study. BMC Pregnancy Childbirth 12:3. https://doi.org/10.1186/1471-2393-12-3

    Article  PubMed  PubMed Central  Google Scholar 

  2. Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L (2015) Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr 169:631–638. https://doi.org/10.1001/jamapediatrics.2015.0358

    Article  PubMed  Google Scholar 

  3. Rana N, Kc A, Målqvist M, Subedi K, Andersson O (2019) Effect of delayed cord clamping of term babies on neurodevelopment at 12 months: a randomized controlled trial. Neonatology 115:36–42. https://doi.org/10.1159/000491994

    Article  PubMed  Google Scholar 

  4. Katheria A, Garey D, Truong G et al (2018) A randomized clinical trial of umbilical cord milking vs delayed cord clamping in preterm infants: neurodevelopmental outcomes at 22–26 months of corrected age. J Pediatr 194:76–80. https://doi.org/10.1016/j.jpeds.2017.10.037

    Article  PubMed  Google Scholar 

  5. American College of Obstetricians and Gynecologists (2010) Interim update. ACOG Comm Opin 131:194–199

    Google Scholar 

  6. Mercer JS, Erickson-Owens DA (2012) Rethinking placental transfusion and cord clamping issues. J Perinat Neonatal Nurs 26:202–217. https://doi.org/10.1097/JPN.0b013e31825d2d9a

    Article  PubMed  Google Scholar 

  7. Purisch SE, Ananth CV, Arditi B et al (2019) Effect of delayed vs immediate umbilical cord clamping on maternal blood loss in term cesarean delivery: a randomized clinical trial. JAMA 322:1869–1876. https://doi.org/10.1001/jama.2019.15995

    Article  PubMed  PubMed Central  Google Scholar 

  8. Solanki M, Dewangan M, Anjum S, Ali SM (2017) Effect of timing of umbilical cord clamping on hemoglobin and hematocrit levels in preterm deliveries. Int J Med Paediatr Oncol 3:115–118

    Google Scholar 

  9. Erickson-Owens DA, Mercer JS, Oh W (2012) Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial. J Perinatol 32:580–584. https://doi.org/10.1038/jp.2011.159

    Article  CAS  PubMed  Google Scholar 

  10. Zhou YB, Li HT, Zhu LP, Liu JM (2014) Impact of cesarean section on placental transfusion and iron-related hematological indices in term neonates: a systematic review and meta-analysis. Placenta 35:1–8. https://doi.org/10.1016/j.placenta.2013.10.011

    Article  CAS  PubMed  Google Scholar 

  11. Tran CL, Parucha JM, Jegatheesan P, Lee HC (2020) Delayed cord clamping and umbilical cord milking among infants in California neonatal intensive care units. Am J Perinatol 37:151–157. https://doi.org/10.1055/s-0039-1683876

    Article  PubMed  Google Scholar 

  12. Cavallin F, Galeazzo B, Loretelli V et al (2019) Delayed cord clamping versus early cord clamping in elective cesarean section: a randomized controlled trial. Neonatology 116:252–259. https://doi.org/10.1159/000500325

    Article  PubMed  Google Scholar 

  13. Oddie S, Rhodes P, Very Preterm Birth Qualitative Collaborative Group (2014) Barriers to deferred cord clamping in preterm infants. Arch Dis Child Fetal Neonatal Ed 99:F391–F394. https://doi.org/10.1136/archdischild-2014-305968

    Article  Google Scholar 

  14. McDonald SJ, Middleton P, Dowswell T, Morris PS (2014) Cochrane in context: effect of timing of umbilical cord clamping in term infants on maternal and neonatal outcomes. Evid Based Child Health 9:398–400. https://doi.org/10.1002/ebch.1965

    Article  PubMed  Google Scholar 

  15. Songthamwat M, Witsawapaisan P, Tanthawat S, Songthamwat S (2020) Effect of delayed cord clamping at 30 seconds and 1 minute on neonatal hematocrit in term cesarean delivery: a randomized trial. Int J Womens Health 12:481–486. https://doi.org/10.2147/IJWH.S248709

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Qian Y, Ying X, Wang P, Lu Z, Hua Y (2019) Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Arch Gynecol Obstet 300:531–543. https://doi.org/10.1007/s00404-019-05215-8

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rosenkrantz TS, Oh W (2010) Polycythemia and Hyperviscosity in the Newborn, 2nd edn. Cambridge University Press, United Kingdom, pp 127–140

    Google Scholar 

  18. Janus J, Moerschel SK (2010) Evaluation of anemia in children. Am Fam Physician 81(12):1462–1471

    PubMed  Google Scholar 

  19. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191. https://doi.org/10.3758/bf03193146

    Article  PubMed  Google Scholar 

  20. Chantry CJ, Blanton A, Taché V, Finta L, Tancredi D (2018) Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial. Matern Health Neonatol Perinatol 4:16. https://doi.org/10.1186/s40748-018-0083-3

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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 297:1241–1252. https://doi.org/10.1001/jama.297.11.1241

    Article  CAS  PubMed  Google Scholar 

  22. Yao AC, Moinian M, Lind J (1969) Distribution of blood between infant and placenta after birth. Lancet 2:871–873. https://doi.org/10.1016/s0140-6736(69)92328-9

    Article  CAS  PubMed  Google Scholar 

  23. Katheria A, Reister F, Essers J et al (2019) Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants. JAMA 322:1877–1886. https://doi.org/10.1001/jama.2019.16004

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chiruvolu A, Medders A, Daoud Y (2021) Effects of umbilical cord milking on term infants delivered by cesarean section. Am J Perinatol 38:1042–1047. https://doi.org/10.1055/s-0040-1701617

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the nursing and laboratory staff of Acıbadem Maslak Hospital, with special thanks to Marina Akman, Mehri Bazarova, and Merve Demir. We would also like to thank Editage (www.editage.com) for English language editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, Acibadem University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey

    Esra Ozbasli, Ozguc Takmaz, Gozde Unsal, Selin Ozaltin, Faruk Suat Dede & Mete Gungor

  2. Department of Pediatrics, Acibadem Mehmet Ali Aydinlar University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey

    Ebru Kazancı

  3. Department of Biochemistry, Acibadem Mehmet Ali Aydinlar University, Acibadem Maslak University Hospital, Darüşşafaka, Büyükdere Cad. No: 40, Sarıyer, 34457, Istanbul, Turkey

    Ozlem Demirelce

Authors
  1. Esra Ozbasli
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Corresponding author

Correspondence to Esra Ozbasli.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This prospective, randomized study was conducted in a single institution from March to July 2021. The study protocol was approved by the Ministry of Health, Turkish Medicines and Medical Devices Agency (E-66175679–514.11.01–350571) and Medical Ethics Committee of the Institutional Ethical Review Board of Acıbadem Mehmet Ali Aydınlar University School of Medicine (ATADEK-2021–01/44). This study was registered at clinicaltrials.gov (NCT04812223) (https://clinicaltrials.gov/ct2/show/NCT04812223).

Consent to participate

All participants who agreed to participate in this study provided written informed consent on the day of the surgery.

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Ozbasli, E., Takmaz, O., Unsal, G. et al. Effects of cord clamping timing in at-term elective cesarean section on maternal and neonatal outcomes: a randomized trial. Arch Gynecol Obstet 309, 1883–1891 (2024). https://doi.org/10.1007/s00404-023-07054-0

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  • DOI: https://doi.org/10.1007/s00404-023-07054-0

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