Delayed clamping won’t harm mothers, benefits infants

The common practice of clamping an umbilical cord within a minute of birth to reduce the possibility of maternal hemorrhaging may need to be revised, according to a new paper published in The Cochrane Database of Systematic Reviews. The study authors searched the Cochrane Pregnancy and Childbirth Group’s Trials Register to find 15 trials involving a total of 3911 mother and infant pairs. The risk of bias in the trials was considered by the paper’s authors to be moderate in nature.

Despite the common reasoning behind early cord clamping, the study authors found no significant differences between early and late cord clamping when it came to severe postpartum hemorrhaging (risk ratio (RR) 1,05, 95% confidence interval (CI) 0.65 to 1.65; 5 trials with data for 2006 women with a late clamping event rate (LCER) of  ˜3.5%, I² 0%) or postpartum hemorrhage of 500 mL or more (RR 1.17 CI 0.94 to 1.44; 5 trials, 2260 women with a LCER of   ˜12%, I² 0%). Blood loss was reported in only 2 trials, covering 1345 women, and no significant differences were seen between early and delayed clamping. Maternal hemoglobin values (mean differences (MD) -0.12 g/dL; 95% CI -0.30 to 0.06, I² 0%) at 24 to 72 hours after birth were deemed to be not significant.

In infants, there was no significant difference between early and late clamping on neonatal mortality (RR 0.37, 95% CI 0.04 to 3.41, 2 trials, 381 infants with a LCER of ˜1%). However, the mean birthweight was significantly higher in infants who had undergone late clamping (101 g increase 95% CI 45 to 157, random-effects model, 12 trials, 3139 infants, I² 62%).  Hemoglobin concentrations 24 to 48 hours post-birth were significantly lower in those who underwent early clamping (MD -1.49 g/dL, 95% CI -1.78 to -1.21; 884 infants, I² 59%), although this difference was not seen in later assessments. Infants who were clamped early were more likely to be iron deficient at 3 to 6 months than those who had undergone delayed clamping (RR 2.65 95% CI 1.04 to 6.73, 5 trials, 1152 infants, I² 82%).   However, infants who underwent early cord clamping were less likely to require phototherapy for jaundice than delayed cord clamping infants (RR 0.62, 95% CI 0.41 to 0.96, data from 7 trials, 2324 infants with a LCER of 4.36%, I2 0%).  Only one trial looked at long-term neurodevelopmental outcomes, which showed no differences between early and late clamping.

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