Systematic Review of Umbilical Cord Clamping Practices Worldwide [15A]

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Abstract

INTRODUCTION:

Although there is no standard definition of early versus delayed umbilical cord clamping, recent randomized controlled trials demonstrate benefits for both term and preterm infants from the latter. Even a brief delay in cord clamping results in placental transfusion, giving the term neonate approximately 30% more blood volume and the preterm as much as 50%, thereby substantially increasing iron stores within the first few months of life.

METHODS:

A search was conducted to identify studies that included information on umbilical cord clamping practices among maternity care providers worldwide. Databases were searched for English publications from 1990 to the present. Articles were included if they contained information on timing of umbilical cord clamping. Surveys and observational studies were acceptable; topical articles and professional guidelines were excluded.

RESULTS:

Five of 13 articles were focused on umbilical cord clamping whereas the remaining 8 investigated the management of the third stage of labor. The demographics of the studies varied greatly depending on location and research design. Collectively, our review reports on the practices of 1457 obstetricians, 2124 midwives and 181 other maternity care providers. One study reports on 1175 maternity units in 14 distinct countries. Some studies also used direct observation in reporting their results from 884 births.

CONCLUSION:

Delayed cord clamping is rarely practiced despite substantial current evidence in its favor. Many professional organizations even recommend delaying cord clamping as part of their guidelines for the active management of the third stage of labor. Consequently, a change in practice is called for.

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