Abstract
Objective
To assess the impact of deferred (delayed) cord clamping (DCC) and umbilical cord milking in singleton and twin gestations on maternal and infant mortality and morbidity.
Target Population
Women who are pregnant with preterm or term singletons or twins.
Benefits, Harms, and Costs
In preterm singletons, DCC for (ideally) 60 to 120 seconds, but at least for 30 seconds, reduces infant risk of mortality and morbidity. DCC in preterm twins is associated with some benefits. In term singletons, DCC for 60 seconds improves hematological parameters. In very preterm infants, umbilical cord milking increases risk for intraventricular hemorrhage.
Evidence
Searches of Medline, PubMed, Embase, and the Cochrane Library from inception to March 2020 were undertaken using Medical Subject Heading (MeSH) terms and key words related to deferred cord clamping and umbilical cord milking. This document represents an abstraction of the evidence rather than a methodological review.
Validation Methods
The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).
Keywords: Infant, Jaundice, Ligation, Neonatal, Parturition, Premature, Term Birth, Time Factors, Umbilical Cord, Umbilical Cord Blood
SOGC Clinical Practice—Obstetrics Committee (2021): Douglas Black (Chair), Krista Cassell, Mélina Castonguay, Cynthia Chan, Elissa Cohen, Gina Colbourne, Christine Dallaire, Kirsten Duckitt, Sebastian Hobson, Amy Metcalfe, J. Larry Reynolds, Debbie Robinson, Marie-Ève Roy-Lacroix, Kristen Simone, Katherine Tyndall
CPS Fetus and Newborn Committee (2020–2021): Gabriel Altit, Nicole Anderson, Heidi Budden, Leonora Hendson, Souvik Mitra, Michael R. Narvey, Eugene Ng, Nicole Radziminski, Vibhuti Shah
Radha Chari (SOGC Liaison), James Cummings (Committee on Fetus and Newborn, American Academy of Pediatrics Liaison), William Ehman (College of Family Physicians of Canada Liaison), Danica Hamilton (Canadian Association of Neonatal Nurses Liaison), Chloë Joynt (CPS Neonatal-Perinatal Medicine Section Executive Liaison), Chantal Nelson (Public Health Agency of Canada Liaison)
Contributor Information
Sarah D McDonald, Hamilton, Ontario, Canada.
Michael Narvey, Winnipeg, Manitoba, Canada.
William Ehman, Nanaimo, British Columbia, Canada.
Venu Jain, Edmonton, Alberta, Canada.
Krista Cassell, Charlottetown, Prince Edward Island, Canada.