Effect of Early versus Late Cord Clamping Post C/S in Term Infants on Hematological Status at Elmagrife Medical Center, Ajdabiya

Abstract

Delayed cord clamping (DCC) allows continued placental transfusion after birth and may improve neonatal hematological status. This study aimed to compare the effects of early cord clamping (ECC) and DCC on hemoglobin and hematocrit levels in term infants delivered by cesarean section at Al-Magryaf Teaching Hospital. A randomized controlled trial was conducted among 100 women undergoing full-term cesarean section at the Department of Obstetrics and Gynecology, Al-Magryaf Teaching Hospital, from September 2023 to February 2024. Participants were randomly allocated to ECC, with cord clamping within 15 seconds of delivery, or DCC, with clamping after 1 minute. Neonatal blood samples were collected at birth and 24 hours later to assess hemoglobin, hematocrit, mean corpuscular volume, serum ferritin, and total bilirubin. Apgar scores and neonatal clinical outcomes were also recorded. Data were analyzed using SPSS version 25, with p ≤ 0.05 considered statistically significant. Maternal and baseline neonatal characteristics were generally comparable between the two groups. DCC was associated with significantly higher neonatal hemoglobin and hematocrit levels at birth and at 24 hours. At birth, mean hemoglobin was 16.9 ± 2.0 g/dL in the DCC group compared with 15.1 ± 1.9 g/dL in the ECC group (p < 0.0001), while hematocrit was 45.9 ± 7.5% versus 41.5 ± 5.5%, respectively (p = 0.001). At 24 hours, hemoglobin remained significantly higher with DCC (17.7 ± 1.9 vs. 15.5 ± 1.6 g/dL, p < 0.0001), as did hematocrit (48.8 ± 9.0% vs. 44.2 ± 8.9%, p = 0.014). Serum ferritin was also significantly higher after 24 hours in the DCC group (251.9 ± 172.8 vs. 180.3 ± 74.9 ng/mL, p = 0.008). DCC was associated with significantly better Apgar scores at 1 and 2 minutes, while no significant differences were observed in 5-minute Apgar scores, respiratory distress, or resuscitation. Total bilirubin and MCV did not differ significantly between groups. Delayed cord clamping for at least one minute in term infants delivered by cesarean section significantly improved early neonatal hemoglobin, hematocrit, and 24-hour ferritin levels without evidence of increased bilirubin levels or adverse neonatal outcomes. DCC appears to be a beneficial and safe practice and should be considered in routine management of stable term neonates undergoing cesarean delivery.