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Delayed umbilical cord clamping

Delayed umbilical cord clamping is prolongation of the time between delivery of a neonate and clamping of the umbilical cord. Delayed umbilical cord clamping is performed for 25 seconds to 5 minutes after delivery.

The objective of this guideline is to describe the risks and benefits of delayed cord clamping.  Because physiology and morbidity differ widely between preterm and term neonates, these 2 groups have been investigated separately.

Definition: Delayed umbilical cord clamping is prolongation of the time between delivery of a neonate and clamping of the umbilical cord. Immediate umbilical cord clamping is typically performed within 15 seconds of delivery, whereas delayed umbilical cord clamping is performed 25 seconds to 5 minutes after delivery.  Currently, the best data are from studies of preterm neonates.  Limited data of term neonates is available.

Technique:  In the majority of trials, the delay in umbilical cord clamping was 30-45 seconds.  The positioning of the neonate (at the level of the vagina or placed on the maternal abdomen) does not appear to affect the volume of placental transfusion.

Contraindications:  The technique is understudied and data limited among neonates who could theoretically have increased risk of morbidity with delayed umbilical cord clamping, including with congenital anomalies, multiple gestations, and prenatal umbilical artery Doppler studies showing absent or reversed end-diastolic flow.  Caution should also be used in the setting of fetal well-being (such as repetitive decelerations or fetal bradycardia).

Potential Benefits:

  • Preterm infant: reduced need for blood transfusion, lower risk for all grades of intraventricular hemorrhage, lower risk of necrotizing enterocolitis.  The long-term effects are largely unknown.
  • Term infant: reduced rates of iron deficiency at 3-6 months of age.  The long-term effects are largely unknown.

Potential Risks:

  • Maternal: understudied, but no clear risks identified
  • Preterm: no clear risks identified
  • Term: elevated risk of jaundice requiring phototherapy


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