Maternal and neonatal outcomes after delayed vs early cord clamping at cesarean delivery: a systematic review and meta-analysis.

Objective: This study aimed to systematically review maternal and neonatal outcomes after delayed cord clamping compared with early cord clamping at the time of cesarean delivery.

Data Sources: MEDLINE, Embase, and ClinicalTrials.gov were searched from inception through October 5, 2023.

Study Eligibility Criteria: Our population included childbearing people undergoing cesarean delivery, and neonates delivered via cesarean delivery after 23 weeks of gestation. Our intervention was delayed cord clamping (>30 seconds after birth) compared with early cord clamping. Randomized controlled trials and prospective and retrospective comparative studies were included.

Methods: Abstracts and potentially relevant full-text articles were doubly screened, and accepted articles were doubly extracted. Of the 736 abstracts screened, 222 full-text articles were assessed, and 25 studies were included. Fifteen studies reported maternal outcomes, 20 reported neonatal outcomes, and 10 assessed both neonatal and maternal outcomes. Data were extracted by 9 reviewers, and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Random-effects meta-analyses of pooled proportions were conducted. Maternal outcomes included were estimated blood loss, postoperative hematocrit reduction, total surgical time, postpartum hemorrhage, blood transfusion, uterotonic administration, postoperative hemoglobin reduction, and incidence of hysterectomy. Neonatal outcomes included bilirubin levels, hematocrit change, phototherapy, neonatal intensive care unit admissions, Apgar scores at 1 and 5 minutes, mean hemoglobin, cord pH, mortality, need for resuscitation, and blood transfusion.

Results: No difference was noted between delayed and early cord clamping at cesarean delivery for any maternal outcome, including estimated blood loss, postpartum hemorrhage, blood transfusion, surgical time, additional uterotonic administration, change in hemoglobin/hematocrit, and incidence of hysterectomy. Delayed cord clamping was favored for neonatal hematocrit change and bilirubin levels. No difference was noted in the need for phototherapy, neonatal intensive care unit admissions, and Apgar scores.

Conclusion: In agreement with robust physiological evidence, our data suggest that delayed cord clamping improves some neonatal outcomes (including hematocrit and bilirubin levels) for both term and preterm infants born via cesarean delivery compared with early cord clamping, without increasing the risk of adverse maternal outcomes, including maternal bleeding. El resumen está disponible en Español al final del artículo.