Practice Uncertainties Page

When should the umbilical cord be clamped?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4206 (Published 09 September 2015) Cite this as: BMJ 2015;351:h4206
  1. Lelia Duley, professor of clinical trials research1,
  2. Jon Dorling, clinical associate professor in neonatology2,
  3. Gill Gyte, consumer editor3
  1. 1Nottingham Clinical Trials Unit, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
  2. 2Neonatal Unit, School of Medicine, Queens Medical Centre, University of Nottingham
  3. 3Cochrane Pregnancy and Childbirth Group, Department of Women’s and Children’s Health, University of Liverpool, Liverpool Women’s NHS Foundation Trust, Liverpool, UK
  1. Correspondence to: L Duley lelia.duley{at}nottingham.ac.uk

The bottom line

  • In the light of current uncertainty:

  • For healthy term births, wait two to five minutes before clamping the cord or longer if the mother requests

  • For healthy preterm births, wait to clamp the cord for at least one minute or longer if the mother requests

  • For very preterm births not requiring immediate resuscitation, wrap the baby (without compressing the cord) before clamping the cord

  • For infants requiring immediate resuscitation at birth, do not delay resuscitation or delay transfer to the resuscitaire; the cord may need to be clamped to allow resuscitation

  • Record the time of cord clamping in the medical notes for all births

At birth, if the umbilical cord is not clamped immediately blood flow between the baby and placenta continues for a short time; this continued placental transfusion is part of the physiological transition from fetal to neonatal circulation.1 Clamping the cord too quickly may restrict the infant’s ability to cope with this transition.2 3 Healthy babies at term usually adapt without major consequences, but this may affect wellbeing in those born preterm or with an impaired cardiorespiratory circulation. A brief delay in cord clamping may increase neonatal blood volume, but a longer delay may have other advantages, such as a smoother cardiorespiratory transition and more stable blood pressure, irrespective of net change in blood volume. For very preterm infants (<32 weeks’ gestation), improved blood pressure stability may reduce the risk of intraventricular haemorrhage.4 Concerns about deferring (delaying) cord clamping include exacerbation of jaundice, increased blood viscosity owing to greater red cell mass, delayed respiratory support, and hypothermia.

There is no agreement on what constitutes early or deferred cord clamping. At term, placental transfusion is usually complete by two minutes but may continue for up to five minutes,5 and it contributes up to a …

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