title: Maternal outcomes following the initiation of an institutional delayed cord clamping protocol: an observational case-control study.
abstract: OBJECTIVE
  The objective of this study is to evaluate maternal outcomes before and after implementation of an institutional delayed cord clamping (DCC) protocol.
  
  
  METHODS
  We performed a secondary analysis of a retrospective cohort study of deliveries occurring at <34 weeks at a tertiary care center in 2013-2014. About 139 women who underwent early cord clamping were compared with 130 women delivered after DCC protocol implementation. Maternal estimated blood loss (EBL) was the primary outcome of interest. Operative times, post-Cesarean decrease in hemoglobin (Hgb), and rates of post-partum hemorrhage and transfusion were also examined in bivariate and multivariable analyses.
  
  
  RESULTS
  About 75% of post-guideline deliveries had actual DCC. In regression analyses, only Cesarean delivery and multifetal gestation increased EBL. No trends were identified in EBL over time. In post-hoc analysis, the study had over 80% power to detect a difference in post-partum hemorrhage rates of 20%.
  
  
  CONCLUSIONS
  An institutional DCC protocol for deliveries <34 weeks was not associated with an identifiable increase in adverse maternal outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division , Oregon Health & Science University , Portland , OR , USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kuo
authors.affiliation: b Department of Obstetrics and Gynecology , Northwestern University , Chicago , IL , USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gokhale
authors.affiliation: c Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division , University Hospitals Case Medical Center , Cleveland , OH , USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Hackney
authors.affiliation: d Department of Pediatrics, Division of Neonatology, Ramathibodi Hospital , Mahidol University , Salaya , Thailand.
authors.forename: Chayatat
authors.initials: C
authors.lastname: Ruangkit
authors.affiliation: e Department of Pediatrics , Rainbow Babies and Children's Hospital , Cleveland , OH , USA.
authors.forename: Monika
authors.initials: M
authors.lastname: Bhola
authors.affiliation: c Department of Obstetrics and Gynecology, Maternal Fetal Medicine Division , University Hospitals Case Medical Center , Cleveland , OH , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: March
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D006473:Postpartum Hemorrhage / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D061665:Time-to-Treatment; D014470:Umbilical Cord / Q000098:blood supply; D055815:Young Adult
keywords: Delayed cord clamping; maternal outcomes; post-partum hemorrhage; prematurity