Effect of delayed cord clamping on maternal and neonatal outcomes during cesarean delivery in twin pregnancies

Compared with early cord clamping (ECC), delayed cord clamping (DCC) facilitates improved placental transfusion and increases blood volume in singleton pregnancies. However, evidence supporting the use of DCC in twins delivered by cesarean section is limited. The objective of this study was to evaluate the impact of DCC versus ECC on both maternal and neonatal outcomes in twin pregnancies delivered through cesarean section. We conducted a retrospective cohort study that included 280 twin pregnancies at ≥28 weeks that were delivered by cesarean section. A comparison of maternal bleeding complications and neonatal hemoglobin and hematocrit levels, hyperbilirubinemia, and neonatal morbidity outcomes was conducted between the DCC and ECC groups. Among the study cohort, 135 (48.2%) twin pregnancies were in the DCC group, while 145 (51.8%) received ECC. The mean reduction in maternal hemoglobin was significantly greater in the DCC group than in the ECC group (DCC 1.0±1.1 g/l vs. ECC 0.7±1.3 g/l, p=0.042). Despite this, there were no significant differences between the two groups in maternal hemoglobin levels on the first postpartum day or in the incidence of maternal bleeding complications, including postpartum hemorrhage (PPH), blood transfusion, and therapeutic hysterectomy. Notably, the DCC group demonstrated significantly higher levels of neonatal admission hemoglobin, hemoglobin on day 3, and hematocrit on day 3. Furthermore, DCC was associated with a substantial reduction in the risk of neonatal anemia (adjusted OR, 0.244 [95% CI: 0.105-0.566, p<0.001) and intraventricular hemorrhage (aOR, 0.488 [95% CI, 0.157-0.628], p=0.006). The DCC group exhibited a significantly higher incidence of hyperbilirubinemia (aOR, 2.735 [95% CI, 1.735-4.310], p<0.001). However, there was no significant difference in the rate of phototherapy between the DCC and ECC groups (aOR, 0.731 [95% CI, 0.449-1.028], p=0.108). Compared with ECC, DCC did not result in an increased risk of maternal bleeding complications, neonatal mortality or severe adverse neonatal outcomes in twin pregnancies during cesarean delivery. Although DCC elevated neonatal hemoglobin levels and increased the incidence of hyperbilirubinemia, the rate of phototherapy did not increase. Notably, DCC was linked to a significantly reduced risk of neonatal anemia and intraventricular hemorrhage in cesarean-delivered twins.