Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial

Introduction: Although recommended, delayed cord clamping (DCC) is not frequently practised during lower segment caesarean section (LSCS).

Objectives: To assess the effects of DCC during antepartum LSCS on placental delivery and postoperative hemorrhage

Methods: A randomised controlled trial was carried out on 156 women undergoing antepartum LSCS between 37-39 weeks gestation at the Academic Obstetric Unit, Teaching Hospital Mahamodara, Galle from 21st January to 30th April 2013. One surgeon carried out the LSCS and the same operative technique was used on all. The umbilical cord of the baby was clamped at <15 seconds (n=52) or between 60 - 75 seconds (n=52) or between 120 - 135 seconds (n=52) according to a predetermined randomised allocation sequence. Postoperative hemorrhage, time taken for delivery of placenta, requirement of manual removal of placenta and additional uterotonics, and reduction of maternal haemoglobin and haemotocrit 48 - 60 hours after LSCS, were measured. The neonate was monitored for 72 hours.

Results: There were no significant differences in postoperative haemorrhage or neonatal morbidity between the groups. There was a clinically non-significant increase in the time taken for placental delivery. The trend of reduction in the need for manual removal of placentae and additional uterotonics with DCC was not significant. The trend of increased requirement of phototherapy for neonatal jaundice with DCC was not significant.

Conclusions: There were no significant differences in the risk of postoperative haemorrhage, manual removal of placenta, or maternal or neonatal morbidity between early cord clamping and DCC during antepartum LSCS.