Delayed versus immediate cord clamping in dichorionic twins <32 weeks: a retrospective study

J Matern Fetal Neonatal Med. 2023 Dec;36(1):2203300. doi: 10.1080/14767058.2023.2203300.


Objectives: Strong evidence imply that delayed cord clamping (DCC) provides significant benefits for singleton neonates. However, there is little information about the safety or efficacy of DCC in twins to recommend for or against DCC in twins in guidelines. We aimed to determine the effect of DCC on dichorionic twins born at <32 weeks of gestation.

Study design: This is a retrospective cohort study comparing the neonatal and maternal outcomes of immediate cord clamping (ICC) [<15 second (s)] versus DCC (at 60 s). Generalized estimating equations models were performed accounting for twin correlation.

Results: A total of 82 pairs of twins (DCC: 41; ICC: 41) were included in analysis. The primary outcome of death before discharge occurred in 3.66% of twins in the DCC group and 7.32% in the ICC group, without a significant difference between the groups. Compared to ICC group, DCC was associated with increased hemoglobin levels [β1 coefficient 6.51; 95% confidence interval (CI) 0.69-12.32. β2 coefficient 5.80; 95% CI 0.07-11.54] at 12-24 h of life. There were no significant differences between the groups in neonatal death, neonatal major morbidities and maternal bleeding complications, although DCC was associated with higher estimated maternal blood loss in the cesarean section group (p = .005).

Conclusions: DCC for 60 s in dichorionic twins born at <32 weeks of gestation was associated with increased neonatal hemoglobin levels, when compared with ICC. The finding of a higher estimated maternal blood loss by cesarean section in the DCC group calls for further trials to assess maternal safety of this procedure in this patient population.

Keywords: Delayed cord clamping; dichorionic-diamniotic; immediate cord clamping; retrospective cohort study; very preterm twins.

MeSH terms

  • Cesarean Section*
  • Constriction
  • Female
  • Hemoglobins
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Retrospective Studies
  • Twins, Dizygotic
  • Umbilical Cord
  • Umbilical Cord Clamping*


  • Hemoglobins