Deferred Clamping of the Umbilical Cord

Recommended Practice

1. Clamping of the umbilical cord should be deferred for a minimum of 60 seconds unless

there are contraindications. Indications include delivery by Caesarean section, instrumental

delivery and preterm birth without fetal compromise. If a paediatrician is present or

anticipated at delivery the delivering obstetric doctor should discuss cord clamping with the

paediatrician.

2. Uterotonics should be given as usual.

3. It is important to keep the baby warm. For term and preterm babies over 28 weeks

gestation, dry and wrap as soon as the baby is delivered. Keep the baby at or lower than the

level of the uterus.

4. For preterm babies under 28 weeks gestation undergoing deferred cord clamping, the

obstetrician / scrubbed midwife should put the baby without drying from feet to neck into a

sterile plastic bag until the deferred cord clamping procedure is complete. If temperature

control measures cannot be ensured, deferred cord clamping should not be undertaken.

5. Early cord clamping (less than 30 seconds post delivery) should be undertaken in cases of

placenta praevia or morbidly adherent placenta, placental abruption, vasa praevia, or tight

nuchal cord. If the neonate is in unexpectedly poor condition at delivery the attending

paediatrician may wish immediate access to the infant in which case immediate clamping is

appropriate following rapid milking of the cord three times towards the umbilicus.

6. There is no evidence of benefit of deferment beyond 120 seconds. The actual duration of

deferment should be recorded in the delivery note / operation note and if early clamping

(less than 30 seconds post delivery) takes place, the reason for this variation should be

documented for audit purposes.

7. Where there is need for substantial cord blood samples e.g. stem cell harvesting, the risks

and benefits should be discussed with the mother and a plan agreed and documented.

8. Audit of practice and outcomes should take place.

Background

NICE Guidance (2007) is compatible with deferred clamping of the umbilical cord as part of the

active management of the third stage. More recent UK and international guidelines from RCOG,

ILCOR, UKRC, WHO and FIGO including a Cochrane review of April 2011 and RCOG Statements of

April and November 2011 support deferred clamping. Autotransfusion has been found to

consistently provide a significant proportion (10-20%) of neonatal blood volume.

There is strong evidence that this practice reduces neonatal anaemia, reduces respiratory

morbidity, improves recovery from sepsis, and there is emerging evidence of long-term benefits

for the child.

There are particular benefits in preterm infants, with outcomes of reduced anaemia, necrotising

enterocolitis and intraventricular haemorrhage.

Umbilical cord gases are minimally affected by deferred cord clamping.

Marion Beard 19/12/11

References

Abalos E. Effect of timing of umbilical cord clamping of term infants on maternal and

neonatal outcomes : RHL commentary. The WHO Reproductive Health Library; Geneva:

World Health Organization. 2009.

Farrar D, Airey R, Tuffnell D, et al. Measuring Placental Transfusion forTerm Births: Weighing

Babies At Birth With Cord Intact. Presentation at BMFMS Liverpool 2009. Arch Dis Child

Fetal Neonatal Ed 2009;94: Fa4-Fa10.

Hosono S. Umbilical cord milking reduces the need for red cell transfusions and improves

neonatal adaptation in infants born at less than 29 weeks’ gestation: a randomised

controlled trial. Arch Dis Child Fetal Neonatal Ed 2008;93:F14-9.

ILCOR: Perlman JM, Wyllie J, Kattwinkel J, et al. Part 11: Neonatal Resuscitation 2010

International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular

Care Science with Treatment Recommendations. Circulation 2010

Mercer J, Bewley S. Could early cord clamping harm neonatal stabilisation? Lancet

2009;374:378.

Rabe H, Reynolds GJ, Diaz-Rosello JL. Early versus delayed umbilical cord clamping in

preterm infants. Cochrane Database of Systematic Reviews 2011

RCOG: Clamping of the umbilical cord and placental transfusion. RCOG SAC Opinion paper

14 2009. http://www.rcog.org.uk/files/rcog-corp/uploadedfiles/

SACPaper14ClampingUmbilicalCord09.pdf

RCOG Greentop Guideline 52. Prevention and Management of Postpartum Haemorrhage,

2011 revision.