Cord clamping beyond 3 minutes: Neonatal short-term outcomes and maternal postpartum hemorrhage

Birth. 2022 Dec;49(4):783-791. doi: 10.1111/birt.12645. Epub 2022 May 2.


Background: Delaying cord clamping (CC) for 3-5 minutes reduces iron deficiency and improves neurodevelopment. Data on the effects of CC beyond 3 minutes in relation to short-term neonatal outcomes and maternal risk of postpartum hemorrhage are scarce.

Methods: This was a prospective observational study performed in two delivery departments. Pregnant women with vaginal deliveries were included. Time to CC, estimated postpartum blood loss, and perinatal data were recorded. Spearman's correlation analysis and comparisons between newborns clamped before and after 3 minutes were performed.

Results: In total, 904 dyads were included. The mean gestational age ± standard deviation was 40.1 ± 1.2 weeks. CC was performed at a median time of 6 minutes (range 0-23.5). Apgar scores at 5 and 10 minutes were positively correlated with time to CC (correlation coefficient .140, P < .001 and .161, < .001). There was no correlation between CC time and bilirubin level (correlation coefficient .021, P = .54). The median postpartum blood loss was 300 mL (70-2550 mL), with a negative correlation between CC time and postpartum blood loss (-0.115, P = .001). The postpartum blood loss was larger in the group clamped at ≤3 minutes (median [interquartile range] 400 mL [300-600] vs 300 mL [250-450], [P = .003]].

Conclusions: Umbilical CC times beyond 3 minutes in vaginal deliveries were not associated with negative short-term outcomes in newborns and were associated with a smaller maternal postpartum blood loss. Although CC time as long as 6 minutes could be considered as safe, further research is needed to decide the optimal timing.

Keywords: cord clamping; hyperbilirubinemia; postpartum hemorrhage; umbilical cord.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Constriction
  • Female
  • Humans
  • Infant, Newborn
  • Postpartum Hemorrhage*
  • Postpartum Period
  • Pregnancy
  • Time Factors
  • Umbilical Cord