Impact of a delayed cord clamping protocol on maternal and neonatal outcomes in patients undergoing term cesarean section

Objective Given concerns amongst physicians and other maternity providers for increased maternal blood loss with delayed cord clamping, our objective was to determine the impact of routine delayed clamping with term cesarean section on maternal blood loss metrics. Study design A retrospective cohort study evaluated the impact of delayed cord clamping in term cesareans at our tertiary care center following protocol implementation. The pre-protocol group (PRE) ranged 1 October 2015 to 31 March 2016. The post-protocol (POST) group ranged 1 October 2017 to 31 March 2018. The primary outcome was maternal estimated blood loss (EBL) during cesarean section. Secondary outcomes included maternal transfusion, hemorrhage (EBL > 1,000 mL), and changes in hemoglobin (Hgb) and hematocrit (HCT). Neonatal outcomes were APGAR scores at 1 and 5 min. Results 733 subjects were included, (PRE = 416, POST = 317). Overall 44.7% reported prior cesarean section. Preop differences included only platelets k/mu L (222 vs. 211, p = .015), Hgb g/dL (11.7 vs. 11.9, p = .002) and HCT% (36.2 vs. 35.2, p = .027), with Hgb and HCT differences in opposite clinical directions. EBL actually decreased after the delayed cord clamping protocol (p = .04). The median [interquartile range] was the same (700 [600-800]), but the PRE group had higher proportions of EBL 800-1,000 (16% vs. 11%) and EBL > 1,000 (4.3% vs 3.7%) comprising this statistical difference. There was no difference in maternal transfusion (2.2%), hemorrhage (11.1%), or change in Hgb (Delta = -1.6 g/dL) or HCT (Delta = -4.6%), (all p > .05). APGAR scores were slightly lower in the POST group at 1 min (8 [8-9] vs. 9 [8-9], p = .035) but similar by 5 min (9 [9-9], p = .38). Conclusion Concerns for increased maternal blood loss during cesarean delivery after implementing a routine delayed cord clamping protocol were not supported. While EBL was lower with delayed cord clamping, all differences between groups appear to lack clinical significance. This offers reassuring evidence there is no negative impact on maternal hematologic characteristics including blood loss from the delayed cord clamping protocol.