Delayed Umbilical Cord Clamping in the 21st Century: Indications for Practice.

BACKGROUND: Health care providers have debated the timing of umbilical cord clamping since the days of Aristotle. Delayed cord clamping was the mainstay of practice until about the 1950s when it was changed to immediate clamping on the basis of a series of blood volume studies combined with the introduction of active management of the third stage of labor. However, in recent years, several systematic reviews advise that delayed cord clamping should be used in all births for at least 30 to 60 seconds.

PURPOSE: The purpose of this article is to discuss the physiology of umbilical cord clamping, the potential benefits and adverse effects of delayed cord clamping, and how this affects the advanced practice nurse.

SEARCH STRATEGY: A search of PubMed, Cochrane Reviews, and Clinical Key was used to find relevant research on the topic of umbilical cord clamping.

RESULTS: Potential benefits of delayed cord clamping include decreased frequency of iron-deficiency anemia in the first year of life with improved neurodevelopmental outcomes in term infants, reduced need for blood transfusions, possible autologous transfusion of stem cells, and a decreased incidence of intraventricular hemorrhage. Apprehension exists regarding the feasibility of the practice as well as the potential hindrance of immediate resuscitation.

IMPLICATIONS FOR PRACTICE: There is a need to begin to look for populations for which delayed cord clamping can be implemented.

IMPLICATIONS FOR FUTURE RESEARCH: Recommendations are inconsistent on the patient population and timing; therefore, further studies are needed to understand the multiple variables that affect timing of umbilical cord clamping.