EFFECTS OF EARLY VERSUS DELAYED CORD CLAMPING ON NEONATAL HEMATOCRIT WITHIN A TERTIARY CARE SETUP IN PAKISTAN

: Umbilical cord clamping is a critical component of the third stage of labour. Early cord clamping (ECC) is traditionally performed within 15 seconds of birth, while delayed cord clamping (DCC), performed 30–120 seconds after birth, has been associated with improved neonatal hematological outcomes. DCC may be particularly beneficial in low-resource settings to reduce neonatal anemia. Objective: To evaluate the impact of delayed versus early cord clamping on neonatal hematological and clinical outcomes at 72 hours postpartum. Methods: This quasi-experimental, non-randomized controlled study was conducted at the Department of Obstetrics and Gynaecology, Ziauddin Hospital, Karachi, from May to July 2022. A total of 84 term pregnant women with singleton fetuses ≥2.5 kg were enrolled and allocated consecutively to ECC (n = 42) or DCC (n = 42). Neonates were monitored for jaundice, respiratory distress, anemia, and polycythemia within 24–72 hours postpartum. Hemoglobin, hematocrit, and bilirubin levels were measured at 72 hours. Data were analyzed using SPSS v20; Mann–Whitney U tests were applied for non-parametric variables, with p < 0.05 considered significant. Results: Baseline characteristics were comparable between groups (mean gestational age: ECC 38.0 ± 1.25 vs DCC 37.7 ± 1.22 weeks, p = 0.382; mean birth weight: ECC 2.97 ± 0.45 vs DCC 2.87 ± 0.36 kg, p = 0.256). Median hemoglobin and hematocrit were significantly higher in the DCC group (17.85 g/dL and 54%) compared to ECC (13.35 g/dL and 39%) (p = 0.000). Bilirubin levels were higher in DCC (12 mg/dL) than ECC (5.9 mg/dL) but without clinically significant impact. Anemia was observed in 11.9% of ECC neonates, while no DCC neonates were anemic (p = 0.21). Jaundice, respiratory distress, and polycythemia were comparable between groups. Conclusion: Delayed cord clamping significantly improves neonatal hemoglobin and hematocrit levels, reducing the risk of early-onset anemia without increasing clinically significant adverse outcomes. Integration of DCC into routine obstetric practice represents a cost-effective strategy to enhance neonatal outcomes, particularly in low-resource settings.