Delayed cord clamping and postpartum h emorrhage: what is its effect?

Introduction: The positive effects of delayed cord clamping (DCC) has been extensively researched. In 2015, the American Academy of Pediatrics recommended delayed umbilical cord clamping for at least 30–60s for all infants.Immediate cord clamping(along with a prophylactic uterotonic and controlled cord traction) is part of the intervention bundle known as active management of the third stage of labor. This intervention bundle has consistently been shown to reduce the risk of postpartum hemorrhage (PPH).Thus,there is concern for a potential increase in the risk of PPH with delayed rather than immediate cord clamping.While maternal outcomes with DCC have been less studied to date, an increased risk of PPH secondary to DCC has not been demonstrated.However, there is limited data regarding the maternal safety of delayed cord clamping. We aimed to determine the effect of delayed cord clamping versus early cord clamping (ECC) on postpartum hemorrhage. Method We searched four electronic databases (MEDLINE,EMBASE,CINAHL,Cochrane Database of Systematic Reviews)for the period between January 2012 and January 2020. Result In a Swedish study (2012) the differences between the DCC and ECC groups with regard to PPH(1.2%, p =0.8) and severe PPH(−2.7%,p = 0.3)were small and non-significant.In a retrospective cohort study (2018) of US pregnant women with multiples who delivered liveborn infants, there was no increase in maternal estimate blood loss when DCC was performed comparing to ECC. In a review of five trials that included more than 2,200 women, delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin level or need for blood transfusion.However, when there is increased risk of hemorrhage the benefits of delayed umbilical cord clamping need to be balanced with the need for timely hemodynamic stabilization of the woman. Conclusion: In conclusion,we could successfully implement DCC at both term and preterm deliveries. Overall, according to this review, no differences in maternal bleeding complications were found with DCC compared to ECC. Delayed cord clamping can be done safely without any increased maternal risk.

کلیدواژه ها:

Postpartum hemorrhage ، Delayed cord Clamping ، Early cord clamping