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.
© This article was published in full text in the Journal of Obstetrics and Gynaecology Canada. Vol 44. McDonald, SD, Narvey, M, Ehman, William, Jain, Venu, Cassell, Krista. Guideline No. 424: Umbilical Cord Management in Preterm and Term Infants, P313-322.E1. Copyright The Society of Obstetricians and Gynaecologists of Canada (2022).