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November 19, 2019

Maternal and Infant Outcomes After Different Methods of Umbilical Cord Management

Author Affiliations
  • 1Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
  • 2Department of Clinical Sciences, Lund University, Lund, Sweden
  • 3Department of Neonatology, Skåne University Hospital, Lund, Sweden
JAMA. 2019;322(19):1864-1865. doi:10.1001/jama.2019.16003

Clamping and cutting the umbilical cord immediately after birth of an infant was introduced as an intervention in the mid-20th century concurrent with a change from home to hospital deliveries, without consideration of maternal or fetal effects.1 In the late 1960s, several studies explored the physiology of the placenta-fetal transfusion, examining the effects of the time between delivery of the infant and cord clamping and cutting, of lowering the infant below the placental level to make use of gravity, and of uterotonics (such as oxytocin) and uterine contractions.2-4 In the 1980s, the Bristol third-stage trial involving 1695 women included early cord clamping as one part of active management of the third stage of labor for reducing postpartum hemorrhage but without evidence that cord clamping was a necessary component for active management.5 More recently, randomized clinical trials have demonstrated benefits of cord management by delayed cord clamping or umbilical cord milking for both preterm and term infants.6 A Cochrane review of studies involving preterm infants found a 28% reduction in in-hospital deaths associated with delayed cord clamping.6 Among term infants, higher iron values during the first year of life and better neurodevelopmental outcomes up to 4 years, especially in boys, have been reported.7,8 The evidence led the World Health Organization to publish recommendations to delay cord clamping and cutting for at least 60 seconds for preterm infants and 1 to 3 minutes for term infants to allow for placental transfusion to take place.9 Two studies in JAMA provide new data on the effects of umbilical cord interventions on women undergoing cesarean delivery at term and the effects on preterm infants.