Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.

@article{Rabe2012EffectOT,
  title={Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.},
  author={Heike Rabe and Jos{\'e} Luis Diaz-Rossello and Lelia Duley and Therese Dowswell},
  journal={The Cochrane database of systematic reviews},
  year={2012},
  volume={8},
  pages={
          CD003248
        }
}
BACKGROUND Optimal timing for clamping the umbilical cord at preterm birth is unclear. Early clamping allows for immediate transfer of the infant to the neonatologist. Delaying clamping allows blood flow between the placenta, the umbilical cord and the baby to continue. The blood which transfers to the baby between birth and cord clamping is called placental transfusion. Placental transfusion may improve circulating volume at birth, which may in turn improve outcome for preterm infants… 

Figures from this paper

Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.

TLDR
This Cochrane Review is a further update of a review first published in 2004 and updated in 2012 and includes forty-eight studies, with data available from 40 studies involving 4884 babies and their mothers.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.

TLDR
A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, in light of early iron stores in haemoglobin concentrations, which is likely delayed that jaundice is available for long as access to phototherapy requiring phototherapy.

Optimal timing of umbilical cord clamping for term and preterm babies.

Milking Compared With Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates: A Randomized Controlled Trial

TLDR
Milking the cord four times achieved a similar amount of placento-fetal blood transfusion compared with delaying clamping the cord for 30 seconds, and there was no significant difference in number of neonates undergoing transfusion.

Committee Opinion No. 684: Delayed Umbilical Cord Clamping After Birth.

  • Medicine
    Obstetrics and gynecology
  • 2017
TLDR
The American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth.

Management of Placental Transfusion to Neonates After Delivery.

TLDR
High-quality evidence supporting delayed umbilical cord clamping to promote placental transfusion to preterm and term neonates and potential benefits to the estimated 140 million neonates born globally every year are summarized.

Early Versus Delayed Umbilical Cord Clamping on Physiologic Anemia of the Term Newborn Infant

TLDR
It was found that milking of the umbilical cord five times was associated with higher hemoglobin levels at 6 weeks after birth, at physiological anemia of the fetus and significant but clinically there was no difference between the two groups.

The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial

TLDR
It is suggested that milking of the cord increases the neonate’s initial hematocrit and may lessen the need for transfusion in the neonatal period.

Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial

TLDR
There were no significant differences in the risk of postoperative haemorrhage, manual removal of placenta, or maternal or neonatal morbidity between early cord clamping and DCC during antepartum LSCS.
...

References

SHOWING 1-10 OF 77 REFERENCES

Early versus delayed umbilical cord clamping in preterm infants.

TLDR
Delaying cord clamping by 30 to 120 seconds, rather than early clamping, seems to be associated with less need for transfusion and less intraventricular haemorrhage, and there are no clear differences in other outcomes.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.

TLDR
A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, in light of early iron stores in haemoglobin concentrations, which is likely delayed that jaundice is available for long as access to phototherapy requiring phototherapy.

Committee Opinion No.543: Timing of umbilical cord clamping after birth.

TLDR
Evidence exists to support delayed umbilical cord clamping in preterm infants, when feasible, and the possibility for a nearly 50% reduction in intraventricular hemorrhage, however, currently, evidence is insufficient to confirm or refute the potential for benefits.

Milking Compared With Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates: A Randomized Controlled Trial

TLDR
Milking the cord four times achieved a similar amount of placento-fetal blood transfusion compared with delaying clamping the cord for 30 seconds, and there was no significant difference in number of neonates undergoing transfusion.

The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial

TLDR
It is suggested that milking of the cord increases the neonate’s initial hematocrit and may lessen the need for transfusion in the neonatal period.

Infants' Blood Volume in a Controlled Trial of Placental Transfusion at Preterm Delivery

TLDR
The blood volume was, on average, increased in the DCC group after at least a 30-second delay for both vaginal and cesarean deliveries, and euvolemia was not attained with the third stage management methods outlined above.

Effects of delayed cord clamping in very-low-birth-weight infants

TLDR
A higher hematocrit is achieved by DCC in very-low-birth-weight infants, suggesting effective placental transfusion, and a randomized unmasked controlled trial was performed.

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

TLDR
Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation and it should be performed whenever possible to reduce the need for packed red cell transfusions during the first 6‬ weeks of life.

Delayed cord clamping in preterm infants delivered at 34–36 weeks’ gestation: a randomised controlled trial

TLDR
Immediate clamping of the umbilical cord should be discouraged and a delay in clamping the cord improves haematocrit levels and results in greater vascular stability and less need for packed cell transfusions for anaemia in the first period after birth.
...