Early vs Delayed Umbilical Cord Clamping and its Impact on the Post Partum Blood Loss: A Randomized Controlled Trial

Abstract

Background ABSTRACT There is no formulated guideline on the timing of umbilical cord clamping after childbirth. Studies on timing of cord clamping have usually assessed infant outcomes. Evidence published to date has not clearly established the impact of the timing of cord clamping on postpartum blood loss and necessitates further research. Objectives Primary Objective: To find out the impact of early and delayed cord clamping on the post partum blood loss. Secondary Objective: To find out the impact of early and delayed cord clamping on infant haemoglobin and hematocrit at 90 ±7 days postpartum. Methods A randomized, controlled trial was performed on 183 consenting women fulfilling eligibility criteria in labour ward of a teaching hospital in India. They were randomly assigned into early cord clamping or delayed cord clamping group; other components of active management of third stage of labour being same for all. The duration of third stage of labour was noted. Quantitative assessment of post partum blood loss was done using BRASSS-V drapes and weighing blood soaked pads. Cord blood haemoglobin and hematocrit at birth and infant haemoglobin and hematocrit at 90 ±7 days were estimated. Statistical analysis done using students unpaired ‘t’ test. IV Results Of the 183 recruited ( 88 in early and 95 in delayed cord clamping) , 159 ( 86.89% ) ( 75 in early and 84 in delayed cord clamping group) completed the follow up at the third month whereas 24 ( 13.11% ) lost to follow up ( 13 in early and 11 in delayed cord clamping group) . No difference was noted in the mean blood loss ( 203.52 ±122.74ml versus 200.74±104.07 ml in early and delayed cord clamping respectively ) and the duration of third stage of labour ( Mean: 296.59± 98.97 seconds versus 281.79±104.59 seconds for early and delayed clamping respectively ) . Infant haemoglobin at 90 ±7 days was 11.07 ± 1.27gm/dl versus 12.70± 1.41 gm/dl ( p=0.0000) and infant hematocrit at 90 ±7 days was 34.13±3.93% versus 39.33 ±4.88% in early and delayed clamping respectively. ( p=0.0000) Conclusion The timing of cord clamping has no impact on the mean blood loss and duration of third stage of labour. Delayed clamping significantly increases mean venous haemoglobin and hematocrit at 90 ±7 days without increasing NICU admissions. Hence, delayed umbilical cord clamping should be implemented to reduce the incidence of anaemia in all term infants who do not require immediate resuscitation.