Umbilical Cord Clamping Timing in Preterm Infants Delivered by Cesarean Section


1 Professor of Pediatrics and Neonatology, Womens' Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Neonatologist, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Professor of Obstetrics and Gynecology, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.


Background: The timing of umbilical cord clamping may affect the need to bloodtransfusion and other morbidities of preterm infants. This study aimed to compare three different cord clamping timing (immediate cord clamping, delayed cord clamping and umbilical cord milking) in preterm infants delivered by cesarean section (CS).
Materials and Methods
A controlled randomized clinical trial was done in preterm infants with gestation age less than 32 weeks delivered by CS in AlZahra hospital, Tabriz, Iran from June 2018 up to the end of January 2019. They were randomly allocated in three groups consisted of 30 neonates in each group. Umbilical cord was clamped within 10 seconds after infant delivery in immediate cord clamping (ICC) group, 60 seconds after delivery in delayed cord clamping (DCC) group. Cord was milked toward the infant three times over two seconds duration in umbilical cord milking (UCM) group. All patients were followed until discharge for needing the blood transfusion, bronchopulmonary dysplasia and mortality.
Results: A total of 20 neonates of 90 studied neonates needed blood transfusion during hospital stay, of which,  4 neonates (13.3%) were  in UCM group,  7 neonates (23.3%) in DCC group and 9 patients (30%) in ICC group (P= 0.27). The mean hemoglobin was significantly higher in UCM group at admission and 30 days after birth (P<0.05).
UCM may be as effective as DCC to increase hemoglobin in preterm infants delivered by CS. Although the hemoglobin of infants with DCC and UCM was significantly higher than infants with ICC, the rate of blood transfusion was not significantly decreased during hospital stay.