Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Umbilical cord management matters less for mothers than for infants

Key clinical point: Maternal blood loss was not significantly different for women who had immediate vs. delayed umbilical cord clamping after cesarean deliveries of singleton infants. In a second study, preterm infants had an increased risk of severe intraventricular hemorrhage with umbilical cord milking.

Major finding: At 1 day after surgery, the mean hemoglobin level was 9.8 g/dL in women who underwent immediate umbilical cord clamping vs. 10.1 g/dL in those who had delayed clamping. In a separate study of preterm infants, umbilical cord milking was significantly associated with a higher rate of intraventricular hemorrhage vs. delayed clamping (8% vs. 3%).

Study details: The data come from a randomized clinical trial including 113 women who underwent scheduled cesarean deliveries of term single infants and from a trial of 474 neonates randomized to umbilical cord milking or delayed clamping.

Disclosures: Dr. Purisch received funding from the Maternal-Fetal Medicine Fellow Research Fund for the first study. Coauthor Cynthia Gyamfi-Bannerman, MD, reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine/AMAG Pharmaceuticals, and personal fees from Sera Prognostics outside the submitted work. The second study was supported by NICHD in a grant to Dr. Katheria, who had no financial conflicts to disclose. Coauthor Gary Cutter, PhD, had numerous ties to pharmaceutical companies. The editorialists had no financial conflicts to disclose.


Purisch SE et al. JAMA. 2019 Nov 19. doi: 10.1001/jama.2019.15995; Katheria A et al. JAMA. 2019 Nov 19. doi: 10.1001/jama.2019.16004; Rabe H and Andersson O. JAMA. 2019 Nov 19;322:1864-5. doi: 10.1001/jama.2019.16003.