Publication:

Impact of early versus delayed umbilical cord clamping on post partum blood loss: a randomized controlled trial

Background Evidence published to date has not clearly established the impact of the timing of cord clamping on postpartum blood loss and necessitates further research. The objective was to find out the impact of early and delayed cord clamping on the post partum blood loss and 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.

Results No difference was noted in the mean blood loss (203.52 ± 122.74 ml 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 ± 1.27 gm/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.