Abstract
BackgroundIn 2015, the American Academy of Pediatrics recommended delayed umbilical cord clamping for at least 30–60 s for all infants. However, there is limited data regarding the maternal safety of delayed cord clamping in multiple pregnancies. We aimed to compare the maternal bleeding complications following early cord clamping (ECC) versus of delayed cord clamping (DCC) in multiple pregnancies.MethodsA retrospective cohort study of pregnant women with multiples who delivered live-born infants at Sharp Healthcare Hospitals in San Diego, CA, USA during January 1st, 2016 – September 30th, 2017. Bleeding complications of 295 women who underwent ECC (less than 30 s) were compared with 154 women who underwent DCC (more than 30 s). ECC or DCC was performed according to individual obstetrician discretion.ResultsFour hundred forty-nine women with multiple pregnancies (N = 910 infants) were included in the study. 252 (85.4%) women underwent cesarean section in ECC group vs. 99 (64.3%) in DCC group. 58 (19.7%) women delivered monochorionic twins in ECC group vs. 32 (20.8%) women in DCC group. There was no increase in maternal estimate blood loss when DCC was performed comparing to ECC. There were no differences in operative time, post-delivery decrease in hematocrits, rates of postpartum hemorrhage, bleeding complications, maternal blood transfusions and therapeutic hysterectomy between the two groups.ConclusionsNo differences in maternal bleeding complications were found with DCC in multiple pregnancies compared to ECC. Delayed cord clamping can be done safely in multiple pregnancies without any increased maternal risk.
Highlights
In 2015, the American Academy of Pediatrics recommended delayed umbilical cord clamping for at least 30–60 s for all infants
Our institution holds theoretical concerns regarding performing delayed cord clamping (DCC) in this patient population that DCC can significantly increase the duration of labor due to the delayed time spent with multiple infants which could result in increased blood loss from operation site as well as may precipitate uterine atony
The patients were categorized into two groups; early cord clamping (ECC), defined as a mother who received umbilical cord clamping before 30 s in all infants and DCC, defined as a mother who received umbilical cord clamping at least after 30 s in one or more infants. 30 s was selected as the cutoff point between ECC and DCC for both term and preterm deliveries in our study to be in accordance with national recommendation [17, 18]
Summary
In 2015, the American Academy of Pediatrics recommended delayed umbilical cord clamping for at least 30–60 s for all infants. We aimed to compare the maternal bleeding complications following early cord clamping (ECC) versus of delayed cord clamping (DCC) in multiple pregnancies. In term infants, delayed cord clamping (DCC) increases hemoglobin at birth, improves iron storage and decreases iron deficiency anemia during the first year of life when compared to early cord clamping (ECC) [2]. These effects have translated into improved neurodevelopmental outcomes at 4 years of age [4]. DCC has been shown to reduce mortality [5] Despite these neonatal benefits, there are limited data on maternal outcomes. While previous systematic reviews have reported no association between DCC and maternal risk of postpartum hemorrhage, blood loss at delivery, or need for blood transfusion [2] they have only included vaginal singleton births [6,7,8,9,10,11,12]
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