Impact of early versus delayed umbilical cord clamping on post partum blood loss: a randomized controlled trial
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20150436Keywords:
Umbilical cord clamping, Delayed cord clamping, Early cord clamping, Post partum blood loss, Neonatal haemoglobinAbstract
Background: Evidence published to date has not clearly established the impact of the timing of cord clamping on postpartum blood loss and necessitates further research. The objective was to find out the impact of early and delayed cord clamping on the post partum blood loss and on infant haemoglobin and hematocrit at 90 ±7 days postpartum.
Methods: A randomized, controlled trial was performed on 183 consenting women fulfilling eligibility criteria in labour ward of a teaching hospital in India. They were randomly assigned into early cord clamping or delayed cord clamping group; other components of active management of third stage of labour being same for all. The duration of third stage of labour was noted. Quantitative assessment of post partum blood loss was done using BRASSS-V drapes and weighing blood soaked pads. Cord blood haemoglobin and hematocrit at birth and infant haemoglobin and hematocrit at 90 ±7 days were estimated. Statistical analysis done using students unpaired ‘t’ test.
Results: No difference was noted in the mean blood loss (203.52 ± 122.74 ml versus 200.74± 104.07 ml in early and delayed cord clamping respectively) and the duration of third stage of labour (Mean: 296.59± 98.97 seconds versus 281.79±104.59 seconds for early and delayed clamping respectively). Infant haemoglobin at 90 ±7 days was 11.07 ± 1.27 gm/dl versus 12.70± 1.41 gm/dl (p=0.0000) and infant hematocrit at 90 ±7 days was 34.13±3.93 % versus 39.33 ±4.88 % in early and delayed clamping respectively (p=0.0000).
Conclusion: The timing of cord clamping has no impact on the mean blood loss and duration of third stage of labour. Delayed clamping significantly increases mean venous haemoglobin and hematocrit at 90 ±7 days without increasing NICU admissions.
Metrics
References
McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 200816;(2):CD004074.
Winter C, Macfarlane A, Deneux-Tharaux C, Zhang W-H, Alexander S, Brocklehurst P, et al. Variations in policies for management of the third stage of labour and the immediate management of postpartum haemorrhage in Europe. BJOG. 2007;114:845-54.
Prendiville WJ, Elbourne D, McDonald S. Active versus expectant management in the third stage of labour. Cochrane Database of Systematic Reviews 2000, Issue 3.
Hutton EK, Hassan ES. Late vs. early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007;297(11):1257-8.
Chaparro CM, Neufeld LM, Alavez GT, Cedillo RE-L, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 2006;367:1997–2004.
N Wiberg, K Källén, P Olofsson. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG. 2008;115(6):697-703.
2005-2006 National Family Health Survey (NFHS-3) National Fact Sheet. Ministry of Health and Family Welfare Government of India.
Mercer JS. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health. 2001;46:402-14.
Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anaemic mothers: a randomized controlled trial. Indian Pediatr. 2002;39 (2):130-5.
Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, et al. The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial. Pediatrics. 2006;117(4):779-86.
van Rheenen P, Brabin BJ. Late umbilical cord clamping as an intervention for reducing iron deficiency in term infants in developing and industrialised countries: a systematic review. Ann Trop Paediatr. 2004;24(1):3-16.
Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004-2006. Int J Gynecol Obstet. 2006;94:243-53.
Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Annals of Internal Medicine. 2001;134:663–94.
Abalos E. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization, 2009.
Geethanath RM, Ramji S, Thirupuram S, Rao YN. Effects of timing of cord clamping on the iron stores of infants at 3 months. Indian Pediatr. 1997;34:103-6.
Versaevel. N, Darling L. Prevention and Management of Postpartum Haemorrhage. AOM Clinical Practice Guideline, No. 9, 2006 Mar. Available from: http://www.aom.on.ca/files/ Office_Documents/Communications/No_9_ Prevention_and_Management_of_PPH.doc.
WHO recommendations for the prevention of postpartum haemorrhage. WHO. Department of Making Pregnancy Safer. Geneva: WHO, 2007.
