Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.
BACKGROUND
Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord greater than one minute after the birth or when cord pulsation has ceased.


OBJECTIVE
To determine the effects of different policies of timing of cord clamping at delivery of the placenta on maternal and neonatal outcomes.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2007).


METHODS
Randomised controlled trials comparing early and late cord clamping.


METHODS
Two review authors independently assessed trial eligibility and quality and extracted data.


RESULTS
We included 11 trials of 2989 mothers and their babies. No significant differences between early and late cord clamping were seen for postpartum haemorrhage or severe postpartum haemorrhage in any of the five trials (2236 women) which measured this outcome (relative risk (RR) for postpartum haemorrhage 500 mls or more 1.22, 95% confidence interval (CI) 0.96 to 1.55). For neonatal outcomes, our review showed both benefits and harms for late cord clamping. Following birth, there was a significant increase in infants needing phototherapy for jaundice (RR 0.59, 95% CI 0.38 to 0.92; five trials of 1762 infants) in the late compared with early clamping group. This was accompanied by significant increases in newborn haemoglobin levels in the late cord clamping group compared with early cord clamping (weighted mean difference 2.17 g/dL; 95% CI 0.28 to 4.06; three trials of 671 infants), although this effect did not persist past six months. Infant ferritin levels remained higher in the late clamping group than the early clamping group at six months.


CONCLUSIONS
One definition of active management includes directions to administer an uterotonic with birth of the anterior shoulder of the baby and to clamp the umbilical cord within 30-60 seconds of birth of the baby (which is not always feasible in practice). In this review delaying clamping of the cord for at least two to three minutes seems not to increase the risk of postpartum haemorrhage. In addition, late cord clamping can be advantageous for the infant by improving iron status which may be of clinical value particularly in infants where access to good nutrition is poor, although delaying clamping increases the risk of jaundice requiring phototherapy.
McDonald
Susan J
SJ
Midwifery Professorial Unit, Mercy Hospital for Women, Level 4, Room 4.071, 163 Studley Road, Heidelberg, Victoria, Australia, 3084.
Middleton
Philippa
P
D003250:Constriction; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007501:Iron / Q000097:blood; D007567:Jaundice, Neonatal / Q000209:etiology* / Q000628:therapy; D007749:Labor Stage, Third; D010789:Phototherapy; D021041:Placental Circulation / Q000502:physiology; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D014470:Umbilical Cord
D007501:Iron