Deferred cord clamping Versus Milking of the Cord in Full Term Vaginal Delivery: A randomized Controlled Trial

Abstract

Summary D uring the first weeks of life, all infants experience a decline in circulating red blood cell (RBC) volume generally expressed as blood hemoglobin (Hb)concentration, normallythisstimulatesasignificant increased production of erythropoietin. However, Evidence suggests that the effects of early versus deferred cord clampingmay differ in preterm and term infants. Currently, insufficient evidence exists to support or refute the benefits from deferred cord clampingfor term infants who are born in settings with rich resources. Although a deferred cord clampingfor up to 60 seconds may increase total body iron stores and blood volume, which may be particularly beneficial in populations in which iron deficiency is prevalent, these potential benefits must be weighed against the increased risk for neonatal phototherapy. This study included 1000 normal vaginal delivery with full term neonates (500 caseswere subjected to deferred cord clamping (DCC) and 500 cases were subjected to umbilical cord milking (UCM). In the DCC group; mean age 26.27 ± 5.47 years(16-43), mean weight 85.04 ± 7.10 Kg, (69-98) and mean height 165.5 ± 3.7 cm (158-181), mean Body Mass Index (BMI) 31.06 ± 2.57 (23.6-37.97) and mean gestational age 39.2 ± 1.05 weeks (38-42), Four of cases had primary post-partum hemorrhage (PPH) none of cases had retained placenta. Infants’ sex of the DCC group was 260 (52%) males and 240 (48%) females with no recorded neonatal complications or ICU admission recorded among them. Mean neonatal weight before deferred clamping was 3.10 ± 0.29 kg (2.51-3.91) while after deferred clamping 3.17 ±0.30 kg. The differences in weight and placental transfusion volume was 74.16 ± 9.66 gm (60-90 gm) and 77.87 ± 10.14 ml (63-94.5) respectively. In the UCM group, the mean age 25.93 ± 5.31 years (16-43), mean weight 85.89 ± 7.05 years (69-99 kg), mean height was 165.39 ±3.54 cm (158-179), mean BMI 31.4 ± 2.7 (23.88-38.76), mean gestational age 39.18 ±1.07 weeks (38-42).Seven of cases had PPH. none of cases had retained placenta. Among 500 infants of the UCM, 234 (46.8%) were males and 266 (53.2%) were females with no recorded neonatal complications or ICU admission recorded among them.The mean neonatal weight before UCM was 3.11 ± 0.3Kg (2.51-4.22) while after UCM was 3.16 ±0.31 (2.19-4.28). The differences in weight and placental transfusion volume among UCM were 52.36 ± 7.68 gm (40-60) and 54.98 ± 8.06 ml (42-63) respectively.

There was a highly significant difference among DCC between weight before and after the procedure (3.1 ± 0.29 Vs 3.17 ±0.3) kg (P=0.001), also among the UCM before 3.10 ±.30 while after was 3.16 ±.31 (p=0.001). Comparison between DCC group and UCM group showed that there is no significant difference as regard age (26.27±5.47) (25.93±5.31) (p=0.32), body weight (85.04 ±7.10) (85.89±7.05) (p= 0.058), Height (cm) (165.50±3.71) (165.39±3.54) (p=0.619), BMI (31.06±2.57) (31.42±2.70) (0.090) and gestational age (39.20±1.05) (39.18±1.07) (0.8) respectively. There is no statistically significant difference between DCC and UCM group as regard neonatal Apgar score at 1 minute (7.66±0.47) (7.68±0.47) (p=0.546) or at 5 minutes (9.00±0.00) (9.00±0.06) (P=0.16) respectively, or as regard PPH(P=0.544). There was non-significant differences between DCC and UCM group regarding birth Weight before procedure (3.10±0.29) (3.11±0.30)(P=0.416), Birth Weight after procedures (3.17±0.30) (3.16±0.31) (P=0.553), whereas there was significant difference regarding weight difference in gm (74.16±9.66) (52.36±7.68) (p<0.001) and Placental Transfusion Volume (in ml) (77.87±10.14) (54.98±8.06) (P<0.001).