Clinical

Delayed cord clamping does not increase risk of postpartum hemorrhage

Last Updated: 2008-04-25 10:49:40 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Clamping the umbilical cord 2 to 3 minutes after the birth of the baby as opposed to within 30 to 60 seconds does not increase the risk of postpartum hemorrhage and may improve the infant's iron status, a review of randomized, controlled trial data suggests.

The downside to delayed clamping, however, is that it may raise the risk of jaundice requiring phototherapy, according to the report in the April 16th online issue of The Cochrane Library.

Along with use of a prophylactic uterotonic drug and controlled traction of the umbilical cord, expeditious clamping of the umbilical cord is a component of the "active management" approach to addressing the third stage of labor and reducing postpartum hemorrhage. The relative benefits of each component, however, were unclear.

"We've started to ask, is it necessary that we do all three? Which part of this is most important? Did timing of clamping the cord make a difference?" lead author Dr. Susan J. McDonald, from La Trobe University in Melbourne, Australia, said in a statement.

The current analysis, which included data from 11 trials involving 2989 mothers and their infants, showed that the timing of cord clamping did not significantly affect the risk of postpartum hemorrhage.

Compared with early clamping, late clamping was associated with an average 2.17 g/dL increase in hemoglobin levels, but no significant differences persisted after 6 months. Ferritin levels were also higher with late clamping and they remained significantly higher in the late clamping group at 6 months.

Late clamping increased the odds of jaundice requiring phototherapy by 41%, the researchers report.

So when should a clinician clamp the umbilical cord? The answer, it seems, may depend on the area in which the clinician is practicing.

In Western countries, delayed clamping may be the favored approach because phototherapy is usually readily available, Dr. McDonald said. Thus, the possible jaundice seen with this approach can be effectively treated, while the infant gleans the benefits of higher iron stores.

"But if you are working in an area where you don't have easy access to treat a child with more severe jaundice, then as a clinician you would need to weigh up the benefits and risks," she said. "Allowing the baby to get the extra blood and maybe become jaundiced is a particular problem if you don't have the facilities. In that case, perhaps, you would err on the side of clamping the cord a little earlier."

The Cochrane Library 2008.