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Maternal bleeding complications and neonatal outcomes following early versus delayed umbilical cord clamping in cesarean deliveries for very low birthweight infants



Determine effect of at least 60 s delayed cord clamping (DCC) on postpartum hemorrhage and maternal estimated blood loss (EBL) in very low birth weight (VLBW) cesarean deliveries when compared to early cord clamping (ECC).

Study design

Retrospective study of VLBW infants at birth. Maternal pre- and post-operative hemoglobin, EBL, and neonatal outcomes were collected.


In total, 620 VLBW infants (DCC = 166, ECC = 454) born to 545 mothers (DCC = 155, ECC = 390) were included. Maternal PPH between DCC was 8% versus ECC was 10% p = 0.52. There were no differences in estimated blood loss or rate of maternal blood transfusion between groups. The post-operative hemoglobin was lower in infants receiving ECC compared to DCC (10.4 [9.4–11.5] versus 10.8 [10.1–11.9] g/dl, p = 0.01). In comparing pre-operative to post-operative hemoglobin there was no difference between DCC and ECC (−1.2 [−2.0 to −0.3] versus −1.2 [−2.1 to −0.6] g/dl, p = 0.46).


DCC of at least 60 s did not increase maternal bleeding complications during VLBW cesarean delivery. To our knowledge, this retrospective study is the largest sample size to date of preterm cesarean deliveries to support maternal safety regarding bleeding complications after delayed cord clamping.

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Data availability

A deidentified dataset is available by written request to the corresponding author.


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ACK was supported by the Cushman Foundation, the Chuck and Ernestina Kreutzkamp Foundation and the Stephen and Lynne Doyle Foundation. We thank the following individuals for their expertise and assistance throughout all aspects of our study: Alexis Rosete, Kaitlyn Fitzgerald, Ana Morales, Elise Mischke, Lukas Linares, Marcie Portillo, and Kathy Arnell.

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All authors contributed to the conceptualization, design, and review of the work. CS substantially contributed to data curation, drafting, and writing manuscript. SAS contributed to data curation and initial manuscript. DMP contributed to data analysis and manuscript revision. ACK co-wrote manuscript and gave final approval of this version.

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Correspondence to Anup C. Katheria.

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Salcido, C., Shahidi, S.A., Poeltler, D.M. et al. Maternal bleeding complications and neonatal outcomes following early versus delayed umbilical cord clamping in cesarean deliveries for very low birthweight infants. J Perinatol 43, 39–43 (2023).

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