ACOG practice committee updates its recommendation regarding timing of cord-clamping.

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The American College of Obstetricians and Gynecologists (ACOG) today made an important announcement regarding the timing of cord clamping in all healthy newborn infants.

In a news release “The American College of Obstetricians and Gynecologists (ACOG) now recommends a delay in umbilical cord clamping for all healthy infants for at least 30-60 seconds after birth given the numerous benefits to most newborns.”[1]

Courtesy: https://combatbootmama.com/2014/11/15/cord-clamping/

The last recommendation was issued in 2012 by the committee which only recommended delayed cord clamping in preterm infants and not for term infants due to lack of sufficient evidence of benefits.

The latest endorsement is based on new research that shows that significant benefits for both preterm and term infants due to the additional blood volume gained from the placenta.

 Maria A. Mascola, MD, the lead author of the Committee Opinion said in the news release “While there are various recommendations regarding optimal timing for delayed umbilical cord clamping, there has been increased evidence that shows that the practice in and of itself has clear health benefits for both preterm and term infants. And, in most cases, this does not interfere with early care, including drying and stimulating for the first breath and immediate skin-to-skin contact.”

Cord  clamps

The current recommendations by ACOG committee on obstetrics practice regarding the timing of umbilical cord clamping after birth are:

• In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
• Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
• Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
• There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
• Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.

The ACOG recommendations does not support nor refute umbilical cord milking because of insufficient evidence of its benefits or harm. There are many ongoing studies comparing benefits and risks of delayed cord clamping versus milking of the umbilical cord in term and preterm infants.

ACOG also does not make any statements for delayed cord clamping in multiple gestations due to lack of sufficient evidence and data.

Those parents consenting for banking of umbilical cord blood needs special counselling as delayed cord clamping decreases the volume and total nucleated cell counts of cord blood donations.

Delayed cord clamping does not have any adverse effect on maternal outcomes nor does it increases the risk of postpartum hemorrhage.

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[1] http://www.acog.org/About-ACOG/News-Room/News-Releases/2016/Delayed-Umbilical-Cord-Clamping-for-All-Healthy-Infants