ABSTRACT
Background: The optimal timing of umbilical cord clamping has been debated in the
scientific literature for over a century. Early clamping of the umbilical cord
is widely practised as part of the management of labour. Early clamping of the
cord was one of the first routine medical interventions in labour. Its place in
modern births was guaranteed by its incorporation into the triad of interventions
that make up the active management of the third stage of labour. Babies who
have immediate cord clamping have also been shown to be more likely to be
anaemic, have decreased fine motor skills, and have decreased social skills during their first few years of age. Delayed
umbilical cord clamping appears to have clear benefit for term infants. Delayed
umbilical cord clamping increases hemoglobin levels at birth and improves iron
stores in the first few months of life, which improve the developmental outcomes.
There is growing evidence that delayed cord clamping is beneficial and can
improve the infant’s iron status for up to 6 months after birth. For the first
few minutes after birth, there is still circulation from the placenta to the
infant. Waiting to clamp the umbilical cord for 2 - 3 min, or until cord
pulsations cease, allows a physiological transfer of placental blood to the infant
(placental transfusion), the majority of which occurs within 3 min. This
placental transfusion provides sufficient iron reserves for the first 6 - 8
months of life, preventing or delaying the development of iron deficiency until
other interventions. WHO’s findings suggest that late cord clamping (one to
three minutes after delivery or longer) is recommended for all births. Aim
of the study: 1) To evaluate the benefit of delayed cord clamping on the infant’s
health status. 2) To assess hemoglobin, iron and ferritin at birth and at 4
months of age in infants who underwent early cord clamping (at 30 seconds) as
compared with infants who underwent delayed cord clamping (at 60 seconds). Methods: A randomized controlled trial was conducted in Benghazi Medical Center and
Elmgharif Hospital at Ejdabia. Study population was 256 women. The participants
were randomized to delayed cord clamping or early cord clamping study groups.
The data were checked manually for completeness, coded and analyzed by using
Statistical Package for Social Sciences (SPSS). The incidence, relative risk,
risk reduction, frequency percentage, mean, and standard deviation were used. Also t-test and chi sequare test (to test
difference between means and proportions respectively) were used to compare
between early and late cord clamping groups. Results: Two hundred forty
seven participants completed the study (the attrition rate was 3.5%); 121 (49%)
were control group (early cord clamping) and 126 (51%) were study group
(delayed cord clamping) group. At birth no significant difference between two
groups regarding the level of hemoglobin, iron and ferritin. At 4th month of age delayed cord clamping was associated with improved hemoglobin,
iron and ferritin and that the incidence of anemia among infants who exposed to
delayed cord clamping was 0.07, while the incidence of anemia among the infants
who exposed to early cord clamping was 0.5. Conclusion: There was strong
association between delayed umbilical cord clamping and improvement of iron
indices and developmental mile stones in infants at 4th month of
age.