Effects of Delayed Umbilical Cord Clamping at Different Timings on Neonatal Hemoglobin and Maternal Blood Loss During Cesarean Delivery at Term: A Randomized Controlled Trial - 16/07/25

Doi : 10.1016/j.jpeds.2025.114620

Qinfeng Song, MSc ^1,², Hongtian Li, PhD ^1,^2,^3,^4,^{^{∗
Contributed equally as co-senior authors.}}, Yingchao Mu, MD ⁵, Ying Xiong, MD ⁶, Yang Liu, PhD ^1,², Yunzhen Liu, MD ⁶, Caiqin Jin, MD ⁷, Xiaoliang Huang, MD ⁸, Lihua Zhao, MD ⁹, Mingxuan Zhang, MSc ^1,², Yubo Zhou, PhD ^1,^2,⁴, Jianmeng Liu, PhD ^1,^2,^3,^4,^⁎^{^{∗
Contributed equally as co-senior authors.}}
¹ Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, Beijing, China
² Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
³ Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
⁴ State Key Laboratory of Female Fertility Promotion, Peking University, Beijing, China
⁵ Department of Prevention and Health Care, Women and Children's Health Care Hospital of Huantai, Zibo, Shandong, China
⁶ Department of Obstetrics and Gynecology, Liuyang Maternal and Child Health Care Hospital, Liuyang, Hunan, China
⁷ Department of Obstetrics and Gynecology, Women and Children's Health Care Hospital of Huantai, Zibo, Shandong, China
⁸ Department of Child Health Care, Liuyang Maternal and Child Health Care Hospital, Liuyang, Hunan, China
⁹ Department of Child Health Care, Women and Children's Health Care Hospital of Huantai, Zibo, Shandong, China

^∗Reprint requests: Jianmeng Liu, PhD, Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, School of Public Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, ChinaInstitute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive HealthSchool of Public HealthPeking University38 Xueyuan RdHaidian DistrictBeijingChina

Abstract

Objective

To examine during cesarean delivery the effects of delayed umbilical cord clamping at different timings vs early clamping in regard to neonatal hemoglobin levels and maternal blood loss.

Study design

In total, 359 pregnant women scheduled for term cesarean delivery at 2 hospitals were randomly assigned to 4 groups: early clamping (<15 seconds; control) or delayed by 30 seconds, 60 seconds, or 90 seconds. Primary outcomes were neonatal hemoglobin levels within 72 hours after delivery; and the change in maternal hemoglobin levels before and after delivery, an indicator of blood loss, with a prespecified noninferiority margin of −0.87 g/dL. The secondary and exploratory outcomes included neonatal hyperbilirubinemia and polycythemia.

Results

Overall adherence to the assigned interventions was 96.1%. Compared with controls, all delayed groups showed significantly higher neonatal hemoglobin levels, with mean differences (95% CI) of 1.17 (0.53-1.80), 0.89 (0.25-1.54), and 1.11 (0.47-1.76) g/dL in groups delayed for 30 seconds, 60 seconds, and 90 seconds, respectively. In regard to the change in maternal hemoglobin levels, lower limits of the 95% CIs for the differences between delayed groups and controls were all higher than the margin (−0.48, −0.11, and −0.37 g/dL, respectively). Secondary and exploratory outcomes did not show any substantial difference across groups.

Conclusions

For term elective cesarean delivery, cord clamping delayed by 30 seconds, 60 seconds, or 90 seconds vs early clamping led to similar increases in neonatal hemoglobin, and was not worse in terms of maternal blood loss.

Registration Site

ClinicalTrials.gov (NCT05492214; clinicaltrials.gov/).

Le texte complet de cet article est disponible en PDF.

Keywords : cesarean delivery, delayed cord clamping, neonatal anemia, maternal blood loss, randomized controlled trial

Abbreviations : CI, CONSORT, DCC, ECC, SD

Plan

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Randomization and Intervention

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Effects of Delayed Umbilical Cord Clamping at Different Timings on Neonatal Hemoglobin and Maternal Blood Loss During Cesarean Delivery at Term: A Randomized Controlled Trial - 16/07/25

Abstract

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Study design

Results

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