Clinical Edge

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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.

Citation:

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.