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New resource alert! Delayed cord clamping at caesarean

Updated: Feb 17, 2021

The problem


One of the many questions hitting our inbox recently is to do with the practice of delayed cord clamping at caesarean section.


As we move practice further towards the stabilisation and resuscitation of the neonate with an intact umbilical cord, one of the very first issues to be addressed is the lack of or minimal timing of delayed cord clamping in theatre.


We recognise that practice is always going to be slow to change. While we wait for practitioner enrolment and trusts to purchase specialist equipment to enable motherside stabilisation, particularly in theatre, we can't ignore that many babies may, in the meantime, be denied adequate time for placental transfusion.


The reason for concern


We know the timing of the clamping and cutting of the umbilical cord has a significant impact on the infant's blood and red cell volume and early iron stores (Erickson-Owens, Mercer and Oh, 2011). This later improving neurological development, white matter gain and fine motor skills (Mercer et al., 2018; Andersson et al., 2011).


The physiology tells us, in utero, at term gestation, one-third of the fetus's blood volume is in the placenta at any one time. At the time of birth, a major shift occurs in the cardiac output to the lungs—changing from 8 to 10% in fetal life to 50% in neonatal life. This shift requires a rapid increase of blood volume to fill the capillary beds surrounding each alveolus to assist with lung tissue recruitment and expansion (Mercer and Skovgaard, 2002).


Receiving placental blood volume ensures a smoother transition and helps to minimise any hypoxic oxidative stress to the neonate.

The issues at caesarean


Maternal post partum haemorrage (PPH)


Kuo et al., (2017) found no clinically significant difference in rates of PPH rates between ECC and DCC groups in their preterm cesarean section study.


Purisch et al., (2019) report in scheduled term caesarean delivery, DCC is not associated with increased maternal blood loss but does achieve higher neonatal Hgb levels at 24-72 hrs of life.


Ruangkit et al., (2018) study considered the theoretical concerns of increased risk of maternal blood loss secondary to increase time spent performing DCC in multiple pregnancies. They found no significant increase in morbidity was found in terms of estimated blood loss, rate of PPH, diagnosis of other bleeding complication or post-cesarean decreases in maternal haemoglobin and hematocrit, maternal blood transfusion or therapeutic hysterectomy between the immediate cord clamping and DCC groups.


Delayed hysterotomy closure (closing of the maternal uterine wall)


Kuo et al., (2017) found no difference in operating room time or maternal PPH rates, suggesting that the practice of DCC itself represents a minimal interruption during cesarean deliveries.


Ruangkit et al's., (2018) study showed no significant increase in delayed hysterotomy closure, precipitate uterine atony, or operative time in relation to PPH of multiple pregnancies above.


Delayed uterotonic administration


High quality evidence s