A Randomized controlled trial to compare the feto-maternal outcomes after physiologic cord clamping vs delayed cord clamping at one minute in women undergoing elective caesarean section at term

Umbilical cord clamping is a pivotal step in the third stage of labor which serves to separate the newborn from the placenta. The timing of this procedure has become a global point of contention. Although several reputable medical organizations, including the American College of Obstetrics and Gynaecologists (ACOG) (9), American Academy of Paediatrics (AAP) [10], European Resuscitation Council [11], National Institute for Health and Care Excellence (NICE) [12], Society of Obstetrician and Gynaecologists of Canada [13], and the World Health Organization [14], advocate for Delayed Cord Clamping (DCC), there is a lack of consistency in its definition. The recommended duration of DCC in these society guidelines ranges from 30 seconds to 5 minutes or even longer, or until umbilical cord pulsation ceases. Surveys on DCC have also highlighted significant variations in its clinical implementation. The World Health Organization (WHO) categorizes early cord clamping as the clamping done within the initial 60 seconds after birth. Conversely, delayed cord clamping occurs between 1 to 3 minutes after birth or when the umbilical cord pulsations cease [1, 2]. In its 2014 Guideline on delayed cord clamping, WHO recommends a delay of at least 60 seconds before clamping, even when positive pressure ventilation is necessary, for both term and preterm infants [1]. This protocol underscores the significance of appropriate timing in ensuring the well-being of newborns during this crucial stage of childbirth. Although most of the leading scientific organisations of obstetrics and neonatology recommend delayed cord clamping, the definition of DCC used vary from one scientific society to another. While most of them recommend delaying clamping the cord to more than 60 seconds (4), some consider that it can be delayed up to 5 minutes if the new born is vigorous and p[laced in skin to skin contact with the mother (5).  The Pan American Health Organization (regional office of the World Health Organization) recommends “The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth) (6).

The advantages of delayed cord clamping, after the delivery of fetus have been widely documented in literature. Nevertheless, the potential impacts on maternal health remain uncertain, warranting a comprehensive investigation into its consequences. To date, only  few studies in the existing literature have focused on maternal mortality and hemorrhage as primary outcomes. Thus, there is a pressing need for additional research to thoroughly evaluate both maternal and neonatal outcomes following the shift in active management during the third stage of delivery (1-3). Allowing the baby to remain attached to the placenta via the umbilical cord after delivery does not pose any negative consequences for both the mother and the newborn. It’s important to recognize that in Western cultures until the 17th century, the practice of clamping and cutting the cord used to occur after the placenta was delivered. The shift to clamping before the placenta’s birth primarily happened for the sake of convenience [7, 8]. Therefore, the present study is planned to compare two different intervals of delayed cord clamping, one after 60 seconds, and second being physiological clamping of the cord after the delivery of placenta by neonatologist, after complete cessation of placental transfusion, on feto-maternal outcomes.