The imperative of implementing delayed cord clamping to improve maternal and neonatal outcomes

02 September 2014
13 min read
Volume 22 · Issue 9

Abstract

Immediately following birth, the newborn remains attached to the mother via the placenta and umbilical cord. During this period, the blood transferred from the placenta to newborn is known as placental transfusion. Placental transfusion can contribute between one-quarter and one-third of the total blood volume of the newborn (80–85 ml/kg) and delayed cord clamping (DCC), can reduce the hypovolemic damage, long term difficulties and even disability associated with early cord clamping (ECC). DCC also increases iron stores in infancy (Andersson et al, 2011); higher iron levels have been found to correlate with improved neurological and cognitive development (Szajewska, 2010). Through integrating DCC into routine third stage management, both mother and newborn can benefit from improved outcomes. With such compelling evidence, why do hospital protocols and guidelines not reflect the latest evidence? And why are women not being given the opportunity for informed choice on such an important issue?.

The third stage of labour begins at the time the newborn is delivered and continues until the placenta and membranes are expelled. Immediately after birth, the newborn remains attached to the mother and placenta via the umbilical cord. The blood volume transferred from the placenta to the newborn during this time is known as placental transfusion. Active management of the third stage of labour is widely practiced and involves a package of interventions aimed at reducing the incidence of postpartum haemorrhage (PPH) (Prendiville et al, 2009), which is a leading cause of maternal morbidity (Lewis, 2011).

The package of interventions include: routine administration of prophylactic uterotonic drugs, early cord clamping (ECC) and cutting, and controlled cord traction (National Institute for Health and Care Excellence (NICE), 2007), although the timing of each component varies. Active management can lead to a reduced risk of PPH, but it is crucial to establish which individual component reduces the risk or if indeed the full ‘package’ is necessary (Soltani et al, 2010; McDonald et al, 2013).

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