December 22, 2016

ACOG Recommends Delayed Umbilical Cord Clamping for All Healthy Infants

WASHINGTON, DC -- December 22, 2016 -- The American College of Obstetricians and Gynecologists (ACOG) now recommends a delay in umbilical cord clamping for all healthy infants for at least 30 to 60 seconds after birth given the numerous benefits to most newborns.

The latest Committee Opinion, published in the January 2017 issue of Obstetrics and Gynecology, is an update to ACOG’s 2012 guidance. The revision is based on more recent research that shows that, while preterm infants are likely to benefit the most from the additional blood volume gained from the placenta, term infants can also benefit and these benefits may have a favourable effect on developmental outcomes.

In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, and decreased need for blood transfusion. It also lowers the incidence of brain haemorrhage and necrotising enterocolitis. For term infants, it increases haemoglobin levels at birth and improves iron stores for several months, which helps prevent iron deficiency during the first year of life.

“While there are various recommendations regarding optimal timing for delayed umbilical cord clamping, there has been increased evidence that shows that the practice in and of itself has clear health benefits for both preterm and term infants,” said Maria A. Mascola, MD, Marshfield Clinic, Marshfield, Wisconsin. “And, in most cases, this does not interfere with early care, including drying and stimulating for the first breath and immediate skin-to-skin contact.”

There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. With that in mind, ob-gyns and other healthcare providers should ensure that the proper mechanisms are in place to monitor and treat it.

Research does not show that delayed cord clamping increases the risk of maternal haemorrhage. According to the Committee Opinion, delayed clamping should not interfere with the active management of the third stage of labour, including efforts to minimise maternal bleeding after birth. In situations when there is maternal haemorrhage or hemodynamic instability, abnormal placentation, need for immediate resuscitation of the infant, or when infant placental circulation is not intact, immediate clamping is appropriate.

Currently, there is not enough evidence to support or refute the benefits of umbilical cord milking, although more research is underway. In the case of umbilical cord blood banking, delayed clamping significantly decreases the yield of cord blood, making it less likely to meet donation or banking criteria. While ACOG finds that the benefits of transfusion at birth likely exceed those of banking blood for future use, immediate cord clamping may increase the amount of cord blood obtained and patients and families who are considering umbilical cord blood banking should be counselled accordingly.

SOURCE: American College of Obstetricians and Gynecologists

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