Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study

J Perinat Med. 2024 Apr 29;52(5):494-500. doi: 10.1515/jpm-2023-0450. Print 2024 Jun 25.

Abstract

Objectives: The University Hospital Basel implemented delayed umbilical cord clamping of 30-60 s in all laboring women on April 1, 2020. This practice has been widely researched showing substantial benefit for the neonate. Few studies focused on maternal blood loss. The objective of our retrospective comparative study was to assess the impact of immediate vs. delayed cord clamping on maternal blood loss in primary scheduled cesarean sections.

Methods: We analyzed data of 98 women with singleton gestations undergoing primary scheduled cesarean section at term. Data from procedures with early cord clamping (ECC) were compared to those after implementation of delayed cord clamping (DCC). Primary outcomes were perioperative change in maternal hemoglobin levels, estimated and calculated blood loss. Secondary outcomes included duration of cesarean section and neonatal data.

Results: There was a statistically significant difference in the mean perioperative decline of hemoglobin of 10.4 g/L (SD=7.92) and 18.7 g/L (SD=10.4) between the ECC and DCC group, respectively (p<0.001). The estimated (482 mL in ECC vs. 566 mL in DCC (p=0.011)) and the calculated blood loss (438 mL in ECC vs. 715 mL in DCC (p=0.002)) also differed significantly. Secondary outcomes showed no significant differences.

Conclusions: In our study DCC resulted in a statistically significant higher maternal blood loss. In our opinion the widely researched neonatal benefit of DCC outweighs the risk of higher maternal blood loss in low-risk patients. However, maternal risks must be minimized, improvements to preoperative blood management and operative techniques are required.

Keywords: delayed cord clamping; early cord clamping; maternal blood loss.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Blood Loss, Surgical* / prevention & control
  • Blood Loss, Surgical* / statistics & numerical data
  • Cesarean Section* / adverse effects
  • Cesarean Section* / methods
  • Cesarean Section* / statistics & numerical data
  • Female
  • Hemoglobins / analysis
  • Humans
  • Infant, Newborn
  • Pregnancy
  • Retrospective Studies
  • Time Factors
  • Umbilical Cord / surgery
  • Umbilical Cord Clamping* / methods

Substances

  • Hemoglobins