Deferred Cord Clamping versus Milking of the Cord in Full Term Vaginal Delivery: A Randomized Controlled Trial

Background: Our study uniquely links the maternal age to deferred cord clamping (DCC) efficacy, a factor not explored in prior trials. Older mothers showed stronger correlations with neonatal weight gain and transfusion volume, suggesting that age-related placental efficiency or vascular dynamics may enhance transfusion. Objective: To evaluate deferred cord clamping as compared to umbilical cord milking in enhancement of placenta-fetal blood transfusion among full term vaginally delivered new born. Patients and methods: We performed a randomized controlled trial in Ain Shams University Maternity Hospital during the period from March 2015 to March 2017 where 1000 vaginally delivered full term pregnant women were included, 500 underwent deferred cord clamping (DCC) and the other 500 underwent cord milking. Results: This randomized controlled trial compared DCC and umbilical cord milking (UCM) in 1,000 term neonates delivered vaginally. DCC (2-minute delay with 30° positioning) resulted in significantly greater neonatal weight gain (74.16 ±9.66 g vs. 52.36 ±7.68 g; p < 0.001) and placental transfusion volume (77.87 ±10.14 mL vs. 54.98 ±8.06 mL; p < 0.001) compared to UCM (20 cm cord milked thrice). Weak but significant correlations were found between maternal age and DCC outcomes (weight: r=0.124; volume: r=0.130; p=0.006), suggesting older mothers benefit more from DCC. In contrast, UCM efficacy correlated positively with gestational age (r=0.123–0.129; p=0.006), indicating advanced gestation enhances milking benefits. No significant sex-based differences were observed in the neonatal weight of either group (DCC: males 73.31±9.48 g vs. females 72.92±9.72 g, p=0.206; UCM: p=0.365). Apgar scores (5-minute: 9±0) showed no correlation with outcomes, confirming the safety of both methods. Maternal BMI and gestational age (DCC group) had no significant impact. Conclusion: The findings highlight DCC as superior for optimizing placental transfusion in term neonates, particularly among older mothers, while UCM remains a viable option in time-sensitive scenarios or advanced gestational ages. Future research should explore long-term hematologic and neurodevelopmental outcomes.