Andersson et al. (2012)


Secondary analysis of DCC (>3 min) and ECC (<10 s) on PPH

N = 382

Exp = 193

Control = 189

No significant difference between ECC and DCC in regards to PPH

Infants’cord gas analysis no significant differences demonstrated.

Andersson et al. (2013)


RCT of full-term infants to have cord clamped at >3 minutes (DCC) or <10 seconds (ECC)-effects on neurodevelopment and infection at four months of age

N = 400



DCC did not appear to affect overall neurodevelopment or symptoms of infection at 4 months.

May be an impact on specific neurodevelopmental domains.

DCC is a safe alternative for infants born at term.

Bhatt, et al. (2013)


RCT animal study of effects of DCC on CV function of preterm lambs

N = 12

Exp = 6

Control = 6

Delaying cord clamping until the onset of ventilation improves CV stability in preterm lambs.

The benefits of DCC may not result from increased blood volume, but from a more stable CV transition to pulmonary respiration.

Blouin et al. (2011)


Pre/post study design of a two component intervention on mean time of cord clamping

N = 234



All deliveries were observed after 3 day training of “best practices” related to cord clamping and a hospital directive. Following interventions mean times to clamping increased to 168.9 seconds from 56.8 seconds.

It is possible to change hospital practice from ECC to DCC with a training program and hospital directive. May help to combat infant anemia in low resource settings.

Ceriani Cernadas, et al. (2006) [3]

RCT of effects of ECC (<15 s) and DCC (1 and 3 min) on venous hematocrit levels

N = 276

ECC = 93

DCC 1 min = 91

DCC 3 min = 92

DCC resulted in higher hematocrit values and fewer incidences of anemia

No significant differences between the groups in regards to bilirubin levels or polycythemia.

Chaparro et al. (2006)


RCT of ECC (<20 s) and DCC (>90 s) on infant iron status

N = 358

Exp = 171

Control = 187

Iron status at 6 months of age was significantly higher in the DCC group

No significant differences between groups in regards to incidence of clinical jaundice or polycythemia. DCC had greater effect on iron status of infants at greater risk for iron deficiency.

Coggins, M., & Mercer, J. (2009) [6]

Literature review, recommendations for practice (AWHONN)

DCC improves iron stores and lessens risk of developing anemia in term infants. DCC in preterm infants is associated with better respiratory function and improved cerebral oxygenation.

DCC not associated with clinical jaundice, polycythemia, or PPH. A delay in cord clamping until pulsation stops is recommended.

Committee on Obstetric Practice (2012)


Literature review describing timing of umbilical cord clamping and the associated benefits of DCC (ACOG)

There is insufficient evidence to support or refute the benefits of DCC

Benefits of DCC may include increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and decreased frequency of iron deficiency in term infants. Benefits must outweigh risks. Current evidence does support DCC in preterm infants. DCC infants may be at increased risk for phototherapy.

Duley et al. (2009) [5]

Royal College of Obstetricians and Gynecologists (RCOG) Opinion paper

Evidence suggests that ECC lowers neonatal hemoglobin and lowers iron stores. Impact on term and preterm infants remain unclear.

More substantive RCTs are required comparing outcomes and long term follow up for mother and baby.

Erickson-Owens et al. (2012) [8]

RCT of ICC (<10 s) and UCM (milked x 5 by the obstetrical provider) in women delivering by cesarean section

N = 24

Exp = 12

Control = 12

UCM results in higher Hct levels at 36 to 48 h of age when compared to ICCU mbilical cord milking can be a viable alternative to DCC

No significant differences between two groups in regards to symptomatic polycythemia, incidence of clinical jaundice, or hyperbilirubinemia.