Physiological Post-placental Cord Clamping in Pregnancies ≥34 Weeks Delivered by Cesarean Section: Maternal and Neonatal Outcomes From a Randomized Controlled Trial

Background Cord clamping practices at birth vary widely. While early cord clamping (ECC) is the practice in cesarean sections (CS), post-placental separation cord clamping (PCC) is avoided due to the potential risk of maternal hemorrhage. This study aimed to document neonatal and maternal safety with PCC practice in CS delivery. Methods A prospective randomized controlled trial conducted between April and December 2022 included 211 pregnant women (PCC arm, n=102; ECC arm, n=109) with a gestation age of >34 weeks scheduled for CS delivery. In the PCC arm, the cord was clamped after placenta separation, and in the ECC arm, it was clamped after 30 seconds along with all other standard care. The primary neonatal outcomes were the clinical outcomes with peripheral oxygen saturation (SpO₂) and heart rate (HR) during the first 15 minutes of life. For the mothers, bleeding amount, postpartum hemorrhage, transfusion need, and hemoglobin change were documented. Results The neonatal parameters, including the SpO₂ and HR values during the first 15 minutes, were comparable between the two groups, with no additional risk of adverse clinical outcomes. Estimated maternal blood loss (402 mL (IQR 330-520 mL) vs. 350 mL (IQR 240-490 mL), p=0.05), mean hemoglobin change (0.8 gm/dL (0.3, 1.6 gm/dL) vs. 0.8 gm/dL (IQR 0.4, 1.5)) and blood transfusion need (6.8% vs. 10.0%) were comparable between the PCC and ECC groups, respectively. Conclusions Implementation of PCC during CS deliveries is feasible, potentially beneficial for term and late preterm neonates and safe for the mothers without any increased risk of bleeding.