No. | Author/Year | Country | Participants | Participants, n | Intervention / Timing | Control / Timing | Outcomes |
---|---|---|---|---|---|---|---|
Umbilical cord milking | |||||||
1 | Atia 2022 | Saudi Arabia | Inclusion: preterm (24.0–34.6 weeks), singleton Exclusion: multifetal pregnancy, diagnosed congenital anomalies, fetal anaemia, considerable antepartum haemorrhage, category III cardiotocography tracing | 200 (Intervention: 100, Control:100) | Cord was milked 4–5 times, at 10 cm/s | Cord was clamped at 45-60 s | Length of hospital stay, neonatal mortality |
2 | Chellappan 2022 | India | Inclusion: preterm (27 – 32 weeks) Exclusion: monochorionic diamniotic twins, intrauterine growth restriction, hydrops fetalis, major congenital anomalies | 179 (Intervention: 93; Control: 86) | Cord was milked 3 times for 10-20 s | Early cord clamping (undefined) | Length of hospital stay, neurodevelopmental outcomes at 6–12 months corrected age (Moderate to severe disability), neurological examination, Trivandrum development screening chart; Developmental assessment scale for Indian infants |
3 | Elimian 2014 | USA | Inclusion: singleton, preterm (24 – 34.0 weeks) Exclusion: major fetal structural or chromosomal abnormalities, multiple gestations, maternal diabetes, intrauterine growth restriction, non-reassuring fetal heart tracings | 200 (Intervention: 99; Control: 101) | Cord was clamped after 30 s, and milked 3–4 times | Cord was clamped within 5 s of birth | Neonatal mortality |
4 | El-Naggar 2022 | Canada | Inclusion: singleton, preterm (24—30.6 weeks) Exclusion: monochorionic twins, major congenital anomalies, placental abruption, fetal anaemia, intention to withhold resuscitation | 65 (Intervention:34; Control: 31) | Cord was milked three times, speed 10 cm/s | Cord was clamped within 10 s of birth | Neurodevelopmental outcomes at 36 months corrected age (Bayley Scales of Infant and Toddler development – III), neurological examination, Gross Motor Functional Classification System |
5 | El-Naggar 2018 | Canada | Inclusion: singleton, preterm (24—30.6 weeks) Exclusion: monochorionic twins, major congenital anomalies, placental abruption, fetal anaemia, intention to withhold resuscitation | 73 (Intervention: 37; Control: 36) | Cord was milked three times, speed 10 cm/s | Cord was clamped within 10 s of birth | Neonatal mortality, length of hospital stay |
6 | Erickson-Owens 2012 | USA | Inclusion: singleton, term (> 37 weeks); caesarean delivery Exclusion: maternal medical and obstetric complications, severe anaemia, clotting disorders, suspected intrauterine growth restriction, smoking in pregnancy, non-English speaker, infant with confirmed diagnosis of intrauterine growth restriction, serious congenital anomalies | 24 (Intervention: 12; Control: 12) | Cord was milked five times before clamping | Cord was clamped within 10 s of birth | Admission to NICU |
7 | Hosono 2007 | Japan | Inclusion: singleton, preterm (24 – 28.6 weeks) and/or low birth weight (< 2500 g) Exclusion: multiple births, major congenital anomalies, chromosomal anomalies, hydrops fetalis | 40 (Intervention: 20; Control: 20) | Cord was milked 2–3 times at 20 cm/s before being clamped | Cord was clamped immediately after birth | Neonatal mortality |
8 | Katheria 2014 | USA | Inclusion: singleton, preterm (23 – 31.6 weeks) Exclusion: imminent delivery, monochorionic multiples, incarcerated mothers, placenta previa, concern for abruptions, refusal to perform the intervention by the obstetrician | 60 (Intervention: 30; Control: 30) | Cord was milked at 20 cm over 2 s, repeated twice | Cord was clamped after 14 s (± 9 s) | Neonatal mortality |
9 | Katheria 2015 | USA | Inclusion: singleton, preterm (23 – 31.6 weeks) Exclusion: monochorionic multiples, incarcerated mother, placenta previa, concern for abruption, Rh sensitisation, hydrops, congenital anomalies, obstetrician declined to perform the intervention | 197 (Intervention: 75; Control: 79) | Cord was milked four times over 2 s, with a 1-2 s pause between milking, then clamped at 20 s after birth | Cord was clamped at least 45 s after birth (42 s ± 12 s) | Neonatal mortality |
10 | Katheria 2018 | USA | Inclusion: singleton, Preterm (23 – 31.6 weeks) Exclusion: monochorionic multiples, incarcerated mothers, placenta previa, concern for placental abruption, Rh sensitization, hydrops, congenital anomalies | 135 (Intervention: 70; Control: 65) | Cord was milked over 2 s and then repeated 3 additional times | Delayed cord clamping (45-60 s) | Neurodevelopmental outcomes at 22–26 months CA (Bayley Scales of Infant and Toddler development – III, Gross Motor Functional Classification System, neurological examination) |
11 | Krueger 2015 | USA | Inclusion: singleton, preterm (22 – 31.6 weeks) Exclusion: fetal anomalies, suspected placental abruption | 67 (Intervention: 35; Control: 32) | 1/3 – 2/3 of the length of the umbilical cord was stripped between two fingers 4 times, with 4-5 s pause in between, and clamped after 30 s | Cord was clamped at 30 s after birth | Length of hospital stay, neonatal mortality |
12 | Kumawat 2022 | India | Inclusion: term and late preterm (≥ 34 weeks) Exclusion: short umbilical cord (i.e., < 25 cm), prolapsed cord, abnormal cord and placenta, Rh-negative mothers, hydrops fetalis, delayed cry after birth, gross congenital malformations | 168 (Intervention: 84; Control: 84) | Umbilical cord was cut at 30 s and milked three times at a speed of 10 cm/s | Cord was clamped at 30 s after birth | Admission to NICU |
13 | Mangla 2020 | India | Inclusion: late preterm and term (35.0 – 42.6 weeks) Exclusion: fetal hydrops, major congenital malformation, Rh isoimmunization, new-borns born through meconium-stained liquor who were non-vigorous at birth, forceps or vacuum assisted delivery, new-borns born to HIV positive mother, maternal eclampsia | 144 (Intervention: 72; Control: 72) | Umbilical cord was milked four times and clamped at 12.9 s (± 0.8 s) | Cord was clamped 60 s after birth | Admission to NICU |
14 | Mercer 2016 | USA | Inclusion: singleton, preterm (24 – 31.6 weeks) Exclusion: multiple gestation, prenatally diagnosed major congenital anomalies, severe or multiple maternal illnesses, mothers who were at risk for loss to follow-up | 161 (Intervention: 74; Control: 87) | Cord milked once at 30-45 s after birth | Cord was clamped within 10 s of birth | Neurodevelopmental outcomes at 18–22 months (Bayley Scales of Infant and Toddler development – III: Motor Score only) |
15 | Panburana 2020 | Thailand | Inclusion: singleton, term (37—42 weeks) Exclusion: umbilical cord length less than 25 cm or cord abnormality(such as true knots or cord prolapse), multiple gestation, maternal Rh-negative blood group, positive anti-HIV, positive HBsAg, and syphilis infection during pregnancy, antenatal diagnosed major congenital anomalies of foetus or apparent at birth, fetal hydrops and fetal growth restriction, intrapartum fetal non reassuring or fetal distress, non-vigorous neonates, unstable maternal hemodynamic condition, placenta abruption, placenta previa, uterine rupture, declined to participate | 168 (Intervention: 84; Control: 84) | Cord was milked 3 times, at 25 cm length, at 10 cm/s with 2 s interval and then clamped | Cord was clamped 60 s after birth | Length of hospital stay |
16/17 | Rabe 2011/ Rabe 2016 | UK | Inclusion: singleton, preterm (24 – 32.6 weeks) Exclusion: multiple pregnancies (twins and more), fetal hydrops, rhesus sensitization, major congenital abnormalities | 58 (Baseline -Intervention:; Control:) (2 year FU—Intervention: 22; Control: 17) (3.5 year FU—Intervention: 18; Control: 11) | Cord was milked four times at a speed of 20 cm/s | Cord was clamped at 30 s after birth | Neonatal mortality, length of hospital stay, glucose concentration (on admission), neurodevelopmental outcomes at 2 years and 3.5 years (Bayley Scales of Infant and Toddler development – III) |
18 | Shirk 2019 | USA | Inclusion: singleton, preterm (23 – 34.6 weeks) Exclusion: major and minor congenital anomalies (not including trisomy markers), precipitous delivery that prevented completion of the protocol, placental abruption, uterine rupture, infants known to be at risk of anaemia, patient delivered at outside institution after random assignment. Once enrolled, a patient was excluded if they had a category 3 fetal heart rate tracing or prolonged fetal bradycardia | 204 (Intervention: 100; Control: 104) | Milking / stripping of 20 cm of umbilical cord four times, allowing for refill between each milking manoeuvre | Cord was clamped at 60 s after birth | Neonatal mortality |
19 | Silahli 2018 | Turkey | Inclusion: preterm (≤ 32 weeks) Exclusion: twin-to-twin transfusion syndrome, fetal and maternal bleeding, dysmorphic features, conotruncal heart disease | 75 (Intervention: 38; Control: 37) | Cord was milked at 20 cm, 3 times before clamping | Cord was clamped within 10 s of delivery | Length of hospital stay |
20 | Song 2017 | Korea | Inclusion: preterm (24 -32.6 weeks) Exclusion: multiple gestations, rhesus sensitization, fetal hydrops, major fetal anomalies, no consent provided | 66 (Intervention: 34; Control: 32) | Cord was milked 4 times at 20 cm/s with a 2 s pause, which took approximately 15-20 s | Cord was clamped immediately after delivery | Length of hospital stay, neonatal mortality |
21 | Xie 2022 | China | Inclusion: singleton, preterm (< 34 weeks) Exclusion: postpartum haemorrhage, major congenital anomalies, hydrops fetalis, haemolysis disease, multiple births, SGA infants | 253 (Intervention: 121; Control: 132) | Cord was milked for 2 s, repeated four times | Cord was clamped immediately after birth | Neonatal mortality |
Delayed cord clamping | |||||||
22 | Andersson 2011 | Sweden | Inclusion: singleton, vaginal delivery, term (37.0 – 41.6 weeks) Exclusions: serious congenital malformations, syndromes, other congenital diseases that could affect the outcome measures | 344 (DCC:170; Control:174) | Cord was clamped at 180 s | Cord was clamped ≤ 10 s | Admission to NICU, Admission to NICU for hypoglycaemia |
23 | Andersson 2013 | Sweden | Inclusion: singleton, vaginal delivery, term (> 37 weeks) Exclusion: serious congenital malformations, syndromes, other congenital diseases of the newborn infant that could affect the outcome measures | 365 (DCC: 185; Control: 180) | Cord was clamped at 180 s | Cord was clamped ≤ 10 s | Neurodevelopmental outcomes at 4 months (Ages and Stages Questionnaire) |
24 | Andersson 2014 | Sweden | Inclusion: singleton, vaginal delivery, term (> 37 weeks) Exclusion: serious congenital malformations, syndromes or other congenital diseases of the newborn infant that could affect the outcome measures | 340 (DCC: 172; Control: 168) | Cord was clamped at 180 s | Cord was clamped ≤ 10 s | Neurodevelopmental outcomes at 12 months (Ages and Stages Questionnaire) |
25 | Andersson 2015 | Sweden | Inclusion: vaginal delivery, term (37–41 weeks) Exclusion: serious congenital malformations, syndromes, other congenital diseases of the newborn infant that could affect the outcome measures | 263 (DCC: 141; Control: 122) | Cord was clamped at 180 s | Cord was clamped ≤ 10 s | Neurodevelopmental outcomes at 48 months (Wechsler Preschool and Primary Scale of Intelligence-III; Ages and Stages Questionnaire -3) |
26 | Armanian 2017 | Iran | Inclusion: preterm (< 34 weeks) Exclusion: non-admission to the NICU, twin pregnancy, attending clinician not compliant with the study protocol, parents’ refusal to participate, major congenital anomalies, asphyxia | 60 (DCC: 30; Control: 30) | Cord was clamped 30-45 s after birth | Cord was clamped within 5-10 s | Neonatal mortality, length of hospital stay |
27 | Backes 2016 | USA | Inclusion: singleton, preterm (22.5 – 27.6 weeks) Exclusion: placental abruption, placental previa, multiple gestations, chromosomal abnormalities (including trisomy 21), known major congenital malformations, attending obstetrician refusal to participate | 40 (DCC: 18; Control 22) | Cord was clamped between 30-45 s | Cord was clamped within 10 s | Neonatal mortality, length of hospital stay |
28 | Berg 2021 | Nepal | Inclusion: singleton, late preterm and term (34 – 41 weeks) Exclusion: clinical history of hypertension, infection, diabetes, any chronic medical condition | 347 (DCC: 179; Control: 168) | Cord was clamped at 180 s | Cord was clamped at < 60 s | Neurodevelopmental outcomes at 3 years (Ages and Stages Questionnaire -3) |
29 | Cavallin 2019 | Italy | Inclusion: singleton, elective caesarean section, term (> 39 weeks) Exclusion: multiple gestations, major congenital malformations and/or chromosomic abnormalities, intrauterine growth restriction and/or fetal hydrops, cord abnormalities (i.e., a length < 20 cm, funicular prolapse, or funicular knots) | 80 (DCC: 40; Control: 40) | Cord was clamped > 60 s | Cord was clamped within 10 s | Glucose concentration (at birth) |
30 | Celikel 2022 | Turkey | Inclusion: singleton, late term, term (36–42 weeks) Exclusion: chronic systemic disease, endocrine or metabolic disease during pregnancy, chronic drug or multivitamin use, fetal anomalies, multiple pregnancy, infants with suspected sepsis, anomalies, fetal distress, requiring postnatal resuscitation | 60 (DCC: 28; Control (32) | Cord clamping was done at 60 s | Cord clamping was done within 10 s | Admission to NICU |
31 | Cernadas 2006 | Argentina | Inclusion: singleton, term (> 37 weeks) Exclusion: clinical disease (diabetes, preeclampsia, hypertension), any other complications; congenital malformations or intrauterine growth restriction (estimated fetal weight < 10th percentile) | 254 (DCC: 1 min: 83; 3 min: 83; Control: 88) | Two delayed clamping groups, 60 s (45-75 s) and 3 min (> 150 s) | Cord was clamped within 15-20 s | Admission to NICU, length of hospital stay |
32 | Chen 2018 | China | Inclusion: singleton, term (37.0 – 41.6 weeks), birth weight 2500-400 g, vaginal delivery Exclusion: mothers refusal; congenital fetal anomalies; Apgar < 6 at 1 min, requirement for resuscitation and oxygen therapy, severe IUGR (< 3%), mothers who received cortisone, anticonvulsants, antidepressants, thyroid hormone, or insulin | 720 (DCC: 90 in each group; Control: 90) | The cord was clamped at 30 s, 60 s, 90 s, 120 s and 150 s | Cord was clamped at < 15 s (11.8 ± 2.5 s) | Admission to NICU |
33 | Chopra 2018 | India | Inclusion: low birth weight (< 25000 g) and late preterm (> 35 weeks) Exclusion: placental abruption or previa, congenital malformations, Rh isoimmunised, multiple pregnancies. Post randomization exclusion criteria: infants born at 10th centile, needing resuscitation, infant birth weight ≥ 10th percentile | 113 (DCC: 55; Control: 58) | Cord was clamped > 60 s | Cord was clamped immediately | Incidence of hypoglycaemia (undefined), neonatal mortality |
34 | Das 2018 | India | Inclusion: preterm (30.0–33.6 weeks) Exclusion: multiple pregnancies, major congenital malformation, hydrops fetalis | At 40 weeks = 390 (Intervention:193, Control: 197) At 9–12 months = 349 (Intervention: 171, Control: 178) At 24–30 months = 323 (Intervention: 158, Control: 165) | Cord was clamped at 60 s | Cord was clamped within 10 s | Neurodevelopmental outcomes at 40 weeks post-menstrual age (Amiel-Tison) and 9–12 months corrected age (Denver II) and 24–30 months chronological age (Developmental Assessment Scale for Indian Infants) |
35 | Datta 2017 | India | Inclusion: singleton, preterm (34 – 36.6 weeks) Exclusion: gross congenital anomaly, hydrops, Rhesus negative pregnancy | Baseline: 117 FU: 112 (DCC: Baseline: 58, FU: 54; Control: Baseline:59, FU: 58) | Cord was clamped between 30-60 s | Cord was clamped within 20 s | Neurodevelopmental outcomes at day 1- and 37-weeks CA (Neurobehavioral Assessment of Preterm Infant: motor development score) |
36 | De Angelis 2022 | Italy | Inclusion: singleton, vaginal delivery, term (37–41 weeks) Exclusion: multiple pregnancies, preterm delivery, induced labour, operative delivery, maternal hypertension, abnormal placentation, maternal bleeding disorders, planned cord blood banking | 122 (DCC: 62; Control: 60) | Cord was clamped < 60 s after birth, or when pulsation stopped | Cord was clamped within 15 s | Neonatal mortality, admission to NICU |
37 | De Bernardo 2020 | Italy | Inclusion: elective caesarean section, term (37–42 weeks), birth weight normal for gestational age Exclusion: pathologies, toxicomaniac, those who smoked or took drugs during pregnancy; admitted to NICU or needing resuscitation, new-borns that showed hypoxic-ischemic events: detachment of placenta, prolapse of the funiculus, uterine rupture, shoulder dystocia, premature rupture of fetal membranes, placenta previa, maternal collapse, embolism amniotic, maternal cardiac arrest, monochorionic twins, fetal hydrops, umbilical cord damaged, isoimmunization Rh, respiratory, malformative diseases | 132 (DCC: 66; Control: 66) | Cord was clamped at 60 s | Cord was clamped immediately after birth | Glucose concentration (2 h after birth) |
38 | Digal 2021 | India | Inclusion: singleton, IUGR, fetal weight < 10th percentile, preterm (≥ 28 weeks) Exclusion: hemodynamic instability, placenta previa/abruptio placentae, multiple gestation, Rh-negative blood group, major congenital malformation, fetal hydrops, requiring resuscitation at birth; GA < 28 weeks | 110 (DCC: 55; Control: 55) | Cord was clamped after 60 s | Cord was clamped within 30 s | Admission to NICU, length of hospital stay |
39/40 | Duley 2017 / Armstrong-Buisseret 2019 | UK | Inclusion: preterm (< 32 weeks) Exclusion: monochorionic twins; triplets or higher-order multiple pregnancy, major congenital malformation | 270 (DCC: Baseline: 135; FU: 115; Control: Baseline: 135; FU:103) | Cord was clamped at ≥ 120 s | Cord was clamped within 20 s | Breastfeeding at discharge (undefined), neonatal mortality, length of hospital stay, neurodevelopmental outcomes at 2 years CA (Bayley Scales of Infant and Toddler development -III or Ages and Stages Questionnaire-3) |
41 | Feitosa 2021 | Brazil | Inclusion: singleton, term (37–42 weeks), vaginal delivery Exclusion: High risk pregnancies, forceps delivery, resuscitation of neonate | 580 (DCC: 278; Control: 282) | Cord clamping was done at 8 min (5 – 12.3 min), the umbilical cord was gently palpated every 30 s until pulsation stopped, allowing spontaneous drainage of blood from the placenta to the newborn | Cord remained intact and clamped at 180 s | Breastfeeding at discharge (exclusive), admission to NICU, length of hospital stay |
42 | Hemmati 2020 | Iran | Inclusion: preterm (26 – 34 weeks) Exclusion: parent or clinician refusal, severe congenital anomalies, need for resuscitation, presence of placental abruption, placenta previa, clamping of the cord before or after the specified reference time intervals | 148 (DCC: 69; Control: 79) | Cord was clamped between 30- 45 s | Cord was clamped after 10-15 s | Neonatal mortality, length of hospital stay |
43 | Hofmeyer 1988 | South Africa | Inclusion: singleton, preterm (35 weeks) | 38 (DCC: 24; Control: 14) | Cord was clamped 60 s after birth | Cord was clamped immediately | Neonatal mortality |
44 | Hofmeye, 1993 | South Africa | Inclusion: low birth weight (< 2000 g) | 86 (DCC: 40; Control: 46) | Cord was clamped 60-120 s after birth | Cord was clamped immediately | Neonatal mortality |
45 | Jomjak 2021 | Thailand | Inclusion: singleton, moderate – late preterm (32–36.6 weeks) Exclusion: major severe congenital anomalies, chromosomal abnormalities, multifetal gestations, maternal coagulopathy, maternal anaemia, placenta previa, placenta abruption, fetal non-reassuring, fetal distress, non-vigorous neonate, denied participation | 110 (DCC: 55, Control: 55) | Cord was clamped within 60 s | Cord was clamped within 5 s | Neonatal mortality, admission to NICU, length of hospital stay |
46 | Korkut 2019 | Turkey | Inclusion: singleton, maternal diabetes (any), term (≥ 37 weeks) Exclusion: hydrops fetalis, major congenital anomaly, congenital infection, multiple gestation, no informed consent, any neonates whose birth was not attended by one of the researchers | 80 (DCC: 40; Control: 40) | Cord was clamped at ≥ 60 s | Cord was clamped immediately after birth | Incidence of hypoglycaemia (defined as blood glucose levels of < 2.2 mmol/L in the first 4 h and < 2.5 mmol/L 3–24 h postnatally), severity of hypoglycaemia (severe hypoglycaemia defined as defined as blood glucose levels of < 1.4 mmol/L in the first 4 h and < 1.9 mmol/L 3–24 h postnatally), receipt of treatment for hypoglycaemia, admission to NICU |
46 | Krishnan 2015 | India | Inclusion: singleton, vaginal delivery, term (> 37 weeks) Exclusion: pre-existing medical complications (heart disease, renal failure, other chronic illnesses); on any one of the following drugs (anticonvulsants, antidepressants, thyroid hormone, insulin, chemotherapy, or cortisone); infants anticipated to require resuscitation; major congenital anomalies; infants fed formula before obtaining ferritin levels at 6 weeks of age | 76 (DCC: 37; Control: 39) | Cord was clamped 180 s | Cord was clamped 10 s after birth | Length of hospital stay |
48 | Kugelman 2007 | Israel | Inclusion: preterm (24 – 34.6/7 weeks) Exclusion: parents refused consent; vaginal bleeding due to placenta previa or abruption or placental tear; major anomaly; severe intrauterine growth restriction (IUGR; < 3%); maternal gestational diabetes treated with insulin; suspected twins, twin transfusion syndrome or discordant twins; and maternal drug abuse | 65 (DCC: 30; Control: 35) | Cord was clamped 30-45 s | Cord was clamped < 10 s | Neonatal mortality, glucose concentration (undefined timing—in delivery room), length of hospital stay |
49 | Mercer 2022 | USA | Inclusion: singleton, term (37 – 41.6 weeks) Exclusion: medical or obstetrical complications (hypertension, pre-eclampsia, diabetes, smoking, substance abuse and suspected intrauterine growth restriction), infants with evidence of intrauterine growth restriction, serious congenital anomalies | 41 (DCC: 21; Control: 20) | Cord was clamped at ≥ 5 min (if cord couldn’t be clamped it was milked 5 times before clamping) | Cord was clamped at < 20 s | Neurodevelopmental outcomes at 12 months (Mullen Scale of Early Learning; Brief Infant Toddler Social Emotional Assessment) |
50 | Mercer 2018 | USA | Inclusion: singleton, term (37 – 41.6 weeks) Exclusion: medical or obstetrical complications (hypertension, pre-eclampsia, diabetes, smoking, substance abuse and suspected intrauterine growth restriction) | 56 (DCC: 31; Control: 25) | Cord was clamped at > 5 min. If unable to delay the clamp, cord was milked 5 times before clamping. Clamp time was 172 s ± 188 s) | Cord was clamped < 20 s (28 s ± 7.6 s) | Neurodevelopmental outcomes at 4 months (Mullen Scales of Early learning) |
51 | Mercer 2017 | USA | Inclusion: singleton, term (37 – 41.7 weeks) Exclusion: evidence of medical or obstetrical complications (hypertension, pre-eclampsia, diabetes, smoking, substance abuse and suspected intrauterine growth restriction), infants with evidence of intrauterine growth restriction, serious congenital anomalies | 73 (DCC: 37; Control: 36) | Cord was clamped at > 5 min. If unable to delay the clamp, cord was milked 5 times before clamping | Cord was clamped < 20 s (23.1 s ± 5.9 s) | Breastfeeding at discharge (undefined) |
52 | Mercer 2010 | USA | Inclusion: preterm (24 – 31.6 weeks) Exclusion: obstetrician’s refusal to participate, major congenital anomalies, multiple gestations, intent to withhold care, severe maternal illnesses, placenta abruption or previa | 58 (DCC: 29; Control: 29) | Cord was clamped 30-45 s | Cord was clamped < 10 s | Neurodevelopmental outcomes (Bayley Scales of Infant and Toddler development -II) at 7.3 months CA |
53 | Mercer 2003 | USA | Inclusion: singleton, preterm (24–31.6/7 weeks) Exclusion: obstetrician or parents refused consent, intent to withhold or withdraw care, placenta previa or abruption, maternal bleeding, major anomaly | 32 (DCC: 16, Control: 16) | Cord was clamped 30-45 s | Cord was clamped 5-10 s | Incidence of hypoglycaemia (defined as blood glucose < 2.2 mmol/L in first 4 h postnatally), glucose concentration (within the first 12 h), length of hospital stay |
54 | Nouraie 2019 | Iran | Inclusion: term (> 37 weeks) Exclusion: maternal complications (diabetes, cardiovascular, renal-pulmonary diseases, preeclampsia, placental abruption and polyhydramnios), mothers most recent delivery had not required the use of forceps or vacuum extractors and was not accompanied with complications such as haemorrhage, dystocia or prolonged labour, no history of known developmental (genetic) disorders or congenital anomalies in either parent families, preterm birth, Apgar score of ≥ 7, birth weight > 2.5 kg | 400 (DCC: 200; Control: 200) | Cord was clamped between 90-120 s | Cord was clamped < 60 s | Neurodevelopmental outcomes at 4 months (Ages and Stages Questionnaire) |
55 | Oxford Midwives Research Group. 1991 | UK | Inclusion: vaginal delivery, singleton, term (> 37 weeks) Exclusion: receiving medication other than iron and vitamin supplements; women whose baby was to be adopted; parents who had a specific preference for early or late cord clamping; babies who showed signs of stress in utero | 552 (DCC: 296; Control: 256) | Cord was clamped 180 s after birth, or when pulsation stopped | Cord was clamped “as soon as possible” after birth | Breastfeeding at discharge (undefined) |
56 | Purisch 2019 | USA | Inclusion: singleton, elective caesarean section, term (≥ 37.0 weeks) Exclusion: placenta previa, placenta abruption, prenatally diagnosed fetal anomalies, fetal anaemia, fetal growth restriction, preeclampsia, significant maternal anaemia, bleeding disorders, planned cord blood banking, refusal of blood products, women with caesarean deliveries scheduled on weekends or postponed to evening hours | 113 (DCC: 57; Control: 56) | Cord was clamped at 60 s (63 s, IQR 61-65 s) | Cord was clamped within 15 s (6 s, IQR 5-8 s) | Admission to NICU |
57 | Rana 2019 | Nepal | Inclusion: vaginal delivery, term (> 37 weeks) Exclusions: any complications | 540 (DCC: 270; Control: 270) | Cord was clamped at ≥ 180 s | Cord was clamped at ≤ 60 s | Neurodevelopmental outcomes (Ages and Stages Questionnare-3) at 12 months CA |
58 | Rana 2018 | India | Inclusion: preterm (< 34 weeks) Exclusion: known congenital malformations, serious maternal illnesses (severe preeclampsia or eclampsia, uncompensated heart disease, any abnormal bleeding before cord clamping), twins or triplets, and babies requiring immediate resuscitation at birth | 100 (DCC: 50; Control: 50) | Cord was clamped after 120 s | Cord was clamped < 30 s | Length of hospital stay |
59 | Ranjit 2015 | India | Inclusion: preterm (30 – 36.6 weeks) Exclusion: Rhesus negative blood group, monoamniotic/monochorionic twins, babies who did not receive the intervention due to need for resuscitation at birth | 94 (DCC: 44; Control: 50) | Cord was clamped > 120 s | Cord was clamped immediately | Incidence of hypoglycaemia (undefined), neonatal mortality |
60 | Rashwan 2022 | Egypt | Inclusion: singleton, assigned caesarean section, late term – term (36 – 38.6 weeks) Exclusion: intrapartum surgical complications such as uterine artery injury or lower segment extension, intrauterine fetal demise, medical disorders (anaemia, diabetes mellitus, abnormal placentation, placenta abruption, liquor abnormalities, or anomalous foetuses) | 62 (DCC: 31; Control: 31) | Cord was clamped at 60 s | Cord was clamped within 15 s | Admission to NICU |
61 | Robledo 2022 | Australia | Inclusion: preterm (< 30 weeks) Exclusion: fetal haemolytic disease, hydrops fetalis, twin transfusion, genetic syndromes, malformations | 1419 (DCC: 709; Control: 710) | Cord was clamped at ≥ 60 s | Cord was clamped within 10 s | Neurodevelopmental outcomes at 2 years CA (Major disability as diagnosed by CP, vision loss, deafness, language problems; Ages and Stages Questionnaire-3) |
62 | Ruangkit 2019 | Thailand | Inclusion: multiple gestations, preterm (28–36 weeks) Exclusion: diagnosed major congenital anomaly, twin-to-twin transfusion syndrome, twin anemic-polycythemic sequence, discordant twins (a weight difference of > 20%), neonatal mortality, hydrops, antepartum or intrapartum haemorrhage, when the medical care provider declined performing DCC | 101 (DCC:51; Control: 50) | Cord was clamped at 30-60 s | Cord was clamped immediately (< 5 s) | Neonatal mortality, glucose concentration (on admission), length of hospital stay |
63 | Shao 2022 | China | Inclusion: gestational diabetes, pre-diabetes and non-diabetic pregnancies, term (> 37 weeks) Exclusion: mothers with other pregnancy complications (hypertension disorders, intrahepatic cholestasis of pregnancy, maternal fever, multiple pregnancy, preterm labour, post-term pregnancy, emergency caesarean section, abnormal fetal presentation), birth weight < 2500 g, Apgar score of < 7, neonatal malformation, suspicious fetal distress, neonatal resuscitation, failed cord blood collection failed, missed blood gas parameters | 441 (DCC: GDM:73, non-GDM: 107; Control: GDM:87, non-GDM:101) | Cord was clamped > 30 s | Cord was clamped < 15 s | Glucose concentration (within 15 min) |
64 | Shinohara 2021 | Japan | Inclusion: singleton, vaginal delivery, term (> 37 weeks) Exclusion: maternal complications, fetal complications, emergency caesarean section, transferred to another hospital, not literate in Japanese, unable to return in 4 months | 138 (DCC:68; Control: 70) | Cord was clamped at > 60 s or when pulsation stopped | Cord was clamped within 15 s | Breastfeeding at discharge (exclusive), neonatal mortality, ddmission to NICU |
65 | Soliman 2022 | Egypt | Inclusion: term (> 37 weeks), elective caesarean Exclusion: history of inutero fetal distress, active resuscitation, twin or multiple gestation deliveries; major congenital anomalies, intrauterine growth restriction, perinatal asphyxia, perinatal hypoxic, ischemic event, Apgar score < 5 at 5 min, fetal umbilical artery pH < 7.0, and/or base deficit ≥ 16 mmol/L, presence of multisystem organ failure | 68 (DCC:34; Control: 34) | Cord clamping was done at 120 s | Cord was clamped at 30 s | Glucose concentration (24 h after birth) |
66 | Songthamwat 2020 | Thailand | Inclusion: singleton, vaginal delivery, term (37–41 weeks) Exclusion: severe medical complication (heart disease, chronic hypertension, or renal disease), fetal anomaly, fetal growth restriction, birth asphyxia, heavy bleeding immediately after birth, refusal to participate in the study | 230 (DCC: 1 min: 76, 2 min: 77; Control: 77) | Two delayed clamping groups, 60 s and 120 s | Cord was clamped at 30 s | Admission to NICU |
67 | Songthamwat 2020b | Thailand | Inclusion: singleton, elective caesarean section, term (< 37 weeks) Exclusion: severe medical complication, fetal anomaly, fetal growth restriction, heavy bleeding immediately after birth, refusal to participate in this study, birth asphyxia, non-vigorous infant | 159 (DCC: 80; Control: 79) | Cord was clamped at 60 s | Cord was clamped < 30 s | Admission to NICU |
68 | Tarnow-Mordi 2017 | Australia | Inclusion: preterm (< 30 weeks) Exclusion: fetal haemolytic disease, hydrops fetalis, twin transfusion, genetic syndromes, malformations | 1566 (DCC: 784; Control: 782) | Cord was clamped at ≥ 60 s | Cord was clamped ≤ 10 s | Neonatal mortality |
69 | Ultee 2007 | The Netherlands | Inclusion: vaginal delivery, preterm (34.0 – 36.6 weeks) Exclusion: maternal overt diabetes or gestational diabetes, pregnancy-induced hypertension | 37 (DCC: 18; Control: 19) | Cord was clamped within 180 s | Cord was clamped within 30 s (13.4 ± 5.6 s) | Incidence of hypoglycaemia (defined as < 2.0 mmol/L), glucose concentration (3 h after birth) |
70 | Vural 2018 | Turkey | Inclusion: macrosomia (4000-4500 g), term (37 – 42 weeks) Exclusion: birth weight < 4000 g, need for resuscitation, < 37w or > 42w gestation, congenital heart disease, congenital malformations | 51 (DCC: 25; Control: 26) | Cord clamping at 60 s after birth | Cord was clamped at 15 s after birth | Length of hospital stay |
71 | Yunis 2021 | Egypt | Inclusion: preterm (< 34 weeks), mothers with antenatal diagnosis of placental insufficiency Exclusion: congenital anomaly, chromosomal anomaly, major resuscitation where delay of resuscitation was not possible | 90 (DCC: 60; Control: 30) | Cord was clamped at 60 s | Cord was clamped within 10 s | Incidence of hypoglycaemia (defined by pre-feeding blood glucose level < 2.5 mmol/L), neonatal mortality, length of hospital stay |