Umbilical Cord Clamping: What Are the Benefits
Condition: Delayed Cord Clamping
Study type: Interventional

Summary: 
      Umbilical cord clumping consists in the binding of the umbilical cord by nipper to interrupt
      blood flow from placenta to foetus. Umbilical cord can be clamped within 30s or at least 1
      min after birth. A lot of studies have shown that delayed umbilical cord clamping is
      associated with greater haemoglobin concentration, better iron storage between 3-6 months of
      life and lower incidence for transfusion and neonatal hypotension compared to immediate
      umbilical cord clumping. Newborns subjected to Caesarean Section showed greater value of
      haemoglobin and lower value of red blood cells compared to newborns birth by vaginal
      delivery. Despite evidence of beneficial effects for delayed umbilical cord clamping after
      eutocic delivery, this practice is not yet taken into consideration after elective Caesarean
      Section.
    

Detailed description: 
      Umbilical cord cutting determines the separation of the newborn from mother. Umbilical cord
      clumping consists in the binding of the umbilical cord by nipper to interrupt blood flow from
      placenta to foetus. In the spontaneous labor there are two modalities to obtain umbilical
      cord clamping: the first modality is immediate umbilical cord clamping within 30s from birth.
      The second modality is delayed umbilical cord clamping at least 1 min after birth. After 1
      min, cerebral blood flow is reduced again because of lower cardiac output.

      A lot of studies have shown that delayed umbilical cord clamping is better than the early
      umbilical clamping because delayed umbilical cord clamping is associated with a great
      haemoglobin concentration in the newborns and best iron storage between 3-6 months of life
      and less incidence for transfusion and neonatal hypotension. Experimental studies, executed
      on animals and humans, analysed cardiocirculatory changes in the foetus immediately after
      birth and the importance of the delayed clamping for the hemodynamic stabilization,
      particularly in the lowest gestational age.

      In a recent randomized study conducted in Nepal on 540 newborns, birth by eutocic delivery
      with 39.2 weeks of gestational age, showed that delayed umbilical cord clamping after 3 min
      of life is correlated with a better haemoglobin level and less incidence of anaemia at 8
      months of life. Zhou et al. conducted a meta-analysis that included hematologic parameters
      obtained by umbilical cord, placenta and newborns blood.

      Association of Italian Hospital Gynecologists Obstetricians (AOGOI) declared contraindicated
      conditions to execute a delayed umbilical cord clamping:

      Hypoxic-ischemic events: detachment of placenta, prolapse of the funiculus, uterine rupture,
      shoulder dystocia, premature rupture of fetal membranes, placenta previa, maternal collapse,
      embolism amniotic, maternal cardiac arrest. Monochorionic twins, Fetal Hydrops, Umbilical
      cord damaged, Isoimmunization Rh.

      Researchers concluded that newborns subjected to Caesarean Section showed greater value of
      haemoglobin and lower value of red blood cells compared to newborns birth by vaginal
      delivery. Haematocrit difference was greater between newborns birth by elective Caesarean
      Section compared to those birth by Caesarean Section in labor. Nowadays, researchers found no
      side effects of delayed umbilical cord clamping except a slight increase of phototherapy
      needs.

      Despite evidence of beneficial effects for delayed umbilical cord clamping after eutocic
      delivery, this practice is not yet taken into consideration after elective Caesarean Section.
      The aim of the study protocol is to investigate the effects of the clamping after 1 min from
      birth by elective Caesarean Section on heart rate, saturation, body temperature, bilirubin,
      haematocrit and glycemia.
    

Intervention name(s): Delayed umbilical cord clamping; Immediate umbilical cord clamping
Intervention type(s): Procedure; Procedure
Intervention description(s): Umbilical cord will be clamped after 1 min after the birth of the newborn; Umbilical cord will be clamped immediately after the birth of the newborn
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Newborn; Elective Caesaren Section; Cord Clamping