Abstract
BackgroundDelayed cord clamping in full-term neonates is widely recommended, while in practice, it is rarely implemented in cesarean section due to the fear of neonatal jaundice and excessive maternal blood loss. The optimal timing of cord clamping remains uncertain. This study was to fully evaluate the effects of delayed cord clamping on short-term hematological status and jaundice in term neonates delivered by cesarean section.MethodsThis retrospective study enrolled 796 women, who were allocated into the early cord clamping group (n = 377) and the delayed cord clamping group (n = 419). The latter group was further divided into two subgroups (30–60 s, 61–120 s).The outcomes were neonatal transcutaneous bilirubin levels on 0 to 5 days of life and the rate of phototherapy. For neonates who had blood tests on the first three days of life, their hemoglobin and hematocrit were compared among groups.ResultsCompared with the early cord clamping group, delayed cord clamping merely increased the transcutaneous bilirubin level of neonates on the day of birth rather than that on the following five days. The heel peripheral blood sample size of 1–3 days in the early cord clamping group was 61, 25 and 33, and in the delayed cord clamping group was 53, 46 and 32, respectively. Delayed cord clamping at 30–60 s resulted in the higher neonatal hemoglobin level on day 3 and an increased rate of neonatal polycythemia, without a higher rate of phototherapy. Delayed cord clamping beyond 60 s did not further improve hematological status in term neonates born by cesarean section.ConclusionIn cesarean section, delayed cord clamping for 30–60 s improved the early hematological status of term neonates without the enhanced requirement of phototherapy for neonatal jaundice.
Highlights
Delayed cord clamping in full-term neonates is widely recommended, while in practice, it is rarely implemented in cesarean section due to the fear of neonatal jaundice and excessive maternal blood loss
In the 1960s, Yao et al demonstrated that the blood volume of full-term neonates born through vagina increased by 19.3% at 1min-delayed cord clamping and 32% when umbilical cord pulsation ceased [13]
The median time of cord clamping was less than 15 s in the early cord clamping (ECC) group, 60 s (IQR 50–70) in the delayed cord clamping (DCC) group, 53.5 s (IQR 45–60) in the 30–60 s DCC group, and 76 s (IQR 70–86) in the 61–120 s DCC group
Summary
Delayed cord clamping in full-term neonates is widely recommended, while in practice, it is rarely implemented in cesarean section due to the fear of neonatal jaundice and excessive maternal blood loss. This study was to fully evaluate the effects of delayed cord clamping on short-term hematological status and jaundice in term neonates delivered by cesarean section. The pattern of placental transfusion in vaginal delivery is different from that in cesarean section. In the 1960s, Yao et al demonstrated that the blood volume of full-term neonates born through vagina increased by 19.3% at 1min-delayed cord clamping and 32% when umbilical cord pulsation ceased [13]. Under the condition of cesarean section, clamping the cord beyond 40 s reversed the net flow between the placenta and neonate, resulting in a rebound of the residual placental blood volume [14]. A systematic review and meta-analysis revealed cesarean section was related to a less placental transfusion compared with vaginal delivery [15]
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