A study of the relationship between the delivery to cord clamping interval and the time of cord separation

doi:10.1016/S0266-6138(05)80195-0

Midwifery

Volume 7, Issue 4, December 1991, Pages 167-176

https://doi.org/10.1016/S0266-6138(05)80195-0 Get rights and content

Abstract

A randomised controlled trial of 554 women was carried out to compare the effects of late and early umbilical cord clamping on the time of cord separation. In addition data were collected on maternal and neonatal outcomes. There were no significant differences between the two groups in the duration of cord adherence and neonatal and maternal outcomes. There appeared to be a higher rate of jaundice in the late clamped group which did not reach statistical significance. There was an unexpectedly higher rate of breast feeding at home in the late clamped group which did reach statistical significance. Overall the trial provides no clear evidence for the benefit of early cord clamping (the current policy as part of the active management of the third stage in the UK) on the outcomes considered.

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Cited by (42)

Association between umbilical cord clamping time, hemoglobin and total serum bilirubin in term neonates admitted for phototherapy
2023, Journal of Neonatal Nursing
Citation Excerpt :
Although placental transfusion contributes 30%–40% of blood volume at 1 min after birth, there is paucity of studies investigating the impact of this red cell mass on the risk of developing jaundice (Nakagawa et al., 2015; Yao et al., 1969; Oh, 1986; Chaparro et al., 2006). Recent studies exploring the association between DCC, hyperbilirubinemia and need for phototherapy have found no significant difference rates of hyperbilirubinemia between ECC and DCC infants (Oxford Midwives Research Group, 1991; Andersson et al., 2011; Carvalho et al., 2019; Hutton and Hassan, 2007; McDonald et al., 2013; Mercer et al., 2017; Yang et al., 2019). The present study reflects findings of more recent studies demonstrating no relationship between cord clamping status and TBil regardless of DCT result (Andersson et al., 2011; Carvalho et al., 2019; Cavallin et al., 2019; Hutton and Hassan, 2007; McDonald et al., 2013; Mercer et al., 2017; Mohammad et al., 2021; Yang et al., 2019; Chen et al., 2018).
The aim of the study was to investigate relationship between cord clamping status, total hemoglobin (THb) and total bilirubin (TBil) in term infants requiring phototherapy for neonatal jaundice.
This retrospective study included term infants admitted at the study hospital for management of physiological neonatal jaundice between 2013 and 2019. Associations between THb, TBil, cord clamping status and Direct Coombs Test (DCT) status, as well as correlation between laboratory and blood gas analyzer (BGA) methods were investigated.
258 term infants were included. 147 infants had cord clamping status documented; 111 had unknown cord clamping status. Delayed cord clamping (DCC) was associated with significantly higher mean THb in DCT negative infants only. Negative DCT was associated with higher THb and TBil regardless of cord clamping status. Mean TBil concentration did not change with increasing THb or cord clamping status. The incidence of term infants admitted for phototherapy increased over the study period. There was strong positive correlation between BGA and laboratory assays.
DCC was associated with a higher THb in DCT negative infants only. There was no correlation between THb and TBil. There was strong positive correlation of TBil between BGA and laboratory assays thus supporting BGA use in ambulatory care settings.
2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group
2021, Resuscitation
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
Surgical techniques for performing caesarean section including CS at full dilatation
2013, Best Practice and Research: Clinical Obstetrics and Gynaecology
Citation Excerpt :
One RCT based in UK that randomised women having a vaginal birth to either early or delayed cord clamping (n = 554) showed no difference in the duration of cord adherence and neonatal or maternal outcomes (evidence level 1b).41 Two RCTs have compared the likelihood of infant anaemia in preterm neonates delivered by CS (evidence level 1b).42,43 One of the RCTs, from Germany (n = 40), reports that delayed cord clamping of 45 s results in a reduced need for packed cell transfusions during the first 6 weeks of life.42
Caesarean section (CS) is probably the most commonly performed procedure in obstetrics. Over the past two decades, caesarean delivery has become more commonly used throughout the world, and this increase has generated a number of controversial issues, including what constitutes a suitable indication and what is the proper surgical technique to perform a CS. Many aspects of the operation as it is commonly performed today are not based on randomised trials or techniques that have been proven to be superior by rigorous study, but instead are the culmination of many years of trial and error. This chapter presents the evidence on surgical techniques for performing CS, including CS at full dilatation.
Early versus late cord clamping: Effects on peripheral blood flow and cardiac function in term infants
2008, Early Human Development
In the debate on the best cord clamping time in newborn infants, we hypothesized that late cord clamping enables an increased volemia due to blood transfer to the newborn from the placenta.
To assess whether clamping time can affect limb perfusion and heart hemodynamics in a group of 22 healthy term newborn infants.
A case-control study.
Eleven early-clamped (at 30 s) vaginally-delivered newborn infants were compared with eleven late-clamped (at 4 min) newborns.
The two groups were studied using near-infrared spectroscopy and M-mode echocardiography.
Late cord clamping coincided with a higher hematocrit (median 62% versus 54%) and hemoglobin concentration (median 17.2 versus 15 g/dL), whilst there were no changes in bilirubin level. Echocardiography showed a larger end-diastolic left ventricle diameter (1.7 cm median value versus 1.5) coupled with unvaried shortening and ejection fraction values. There were no changes in calf blood flow, oxygen delivery, oxygen consumption or fractional oxygen extraction calculated from the NIRS measurements, or in foot perfusion index.
Our results demonstrated that late cord clamping coincides with an increased placental transfusion, expressed by higher hematocrit and hemoglobin values, and larger left ventricle diameter at the end of the diastole, with no changes in peripheral perfusion or oxygen metabolism.
Umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis
2024, BMC Pregnancy and Childbirth
The effect of cord clamping time on cord blood gas in term newborn babies delivered by cesarean section
2023, Perinatal Journal

View all citing articles on Scopus

¹: Midwifery Education Centre, John Radcliffe Maternity Unit, Headington, Oxford OX3 9DU, UK

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A study of the relationship between the delivery to cord clamping interval and the time of cord separation

Abstract

Clinics in Perinatology

Midwifery

Midwifery

Lancet

Lancet

European Journal of Obstetrics, Gynecology & Reproductive Biology

Ergonovine and the third stage of labour

Obstetrics and Gynaecology

The management of the umbilical cord in labour

South African Journal of Obstetrics and Gynaecology

The power function of the ‘exact’ test for comparing two binomial distributions

Journal of the Royal Statistical Society (series c). Applied Statistics

Influence of early cord ligation on the transplacental passage of fetal cells

Journal of Obstetrics and Gynaecology of the British Commonwealth

Randomised study of 6 umbilical cord care regimens

Clinical Pediatrics Philadelphia

Early or late cord clamping? A question of optimal time

Weiner Klinische Wochcenschrist