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Time to Clamp the Cord?

November 20, 2012

Washington, DC -- Waiting to clamp the umbilical cord until 30–60 seconds after birth may benefit the health of preterm infants, but no evidence shows that it helps full-term babies, according to a new Committee Opinion issued today by The American College of Obstetricians and Gynecologists (The College) and endorsed by the American Academy of Pediatrics. The ideal time for cord clamping after delivery, even after years of debate, has yet to be definitively established. 

The optimal time to clamp the umbilical cord after delivery has been an ongoing controversy in obstetrics. In most deliveries today, the cord is clamped within 15–20 seconds after birth. Some studies suggest that delaying cord clamping for at least 30–60 seconds benefits newborns by increasing their blood volume, reducing their need for blood transfusions, and lowering the frequency of anemia. Waiting to clamp the cord may increase blood volume and iron stores in term infants, but there also are potential risks such as neonatal polycythemia (excess number of red blood cells) that could impede blood flow.

Preterm infants stand to benefit most from delayed cord clamping, according to The College. Evidence shows that the single most important benefit of delayed cord clamping to preterm infants is the potential for a nearly 50% reduction in bleeding into the brain. Delaying cord clamping for 30–60 seconds in preterm newborns also is associated with improved blood circulation, better red blood cell volume, and lower risk of needing a blood transfusion.

More research is needed to help evaluate the optimal timing of cord clamping. The College emphasizes that collecting cord blood for banking should not interfere with or determine the timing of cord clamping.

Committee Opinion #543 “Timing of Umbilical Cord Clamping After Birth” is published in the December 2012 issue of Obstetrics & Gynecology.

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Other recommendations issued in this month’s Obstetrics & Gynecology:

Practice Bulletin #132 “Antiphospholipid Syndrome” (Revised)
ABSTRACT: Antiphospholipid syndrome (APS) is an autoimmune disorder defined by the presence of characteristic clinical features and specified levels of circulating antiphospholipid antibodies (Box 1 and Box 2). Diagnosis requires that at least one clinical and one laboratory criterion are met. Because approximately 70% of individuals with APS are female (1), it is reasonably prevalent among women of reproductive age. Antiphospholipid antibodies are a diverse group of antibodies with specificity for binding to negatively charged phospholipids on cell surfaces. Despite the prevalence and clinical significance of APS, there is controversy about the indications for and types of antiphospholipid tests that should be performed in order to diagnose the condition. Much of the debate results from a lack of well-designed and controlled studies on the diagnosis and management of APS. The purpose of this document is to evaluate the data for diagnosis and treatment of APS.

Committee Opinion #544 “Over-the-Counter Access to Oral Contraceptives” (NEW!)
ABSTRACT: Unintended pregnancy remains a major public health problem in the United States. Access and cost issues are common reasons why women either do not use contraception or have gaps in use. A potential way to improve contraceptive access and use, and possibly decrease unintended pregnancy rates, is to allow over-the-counter access to oral contraceptives (OCs). Screening for cervical cancer or sexually transmitted infections is not medically required to provide hormonal contraception. Concerns include payment for pharmacist services, payment for over-the-counter OCs by insurers, and the possibility of pharmacists inappropriately refusing to provide OCs. Weighing the risks versus the benefits based on currently available data, OCs should be available over-the-counter. Women should self-screen for most contraindications to OCs using checklists.

Committee Opinion #545 “Noninvasive Prenatal Testing for Fetal Aneuploidy” (NEW!)
ABSTRACT: Noninvasive prenatal testing that uses cell free fetal DNA from the plasma of pregnant women offers tremendous potential as a screening tool for fetal aneuploidy. Cell free fetal DNA testing should be an informed patient choice after pretest counseling and should not be part of routine prenatal laboratory assessment. Cell free fetal DNA testing should not be offered to low-risk women or women with multiple gestations because it has not been sufficiently evaluated in these groups. A negative cell free fetal DNA test result does not ensure an unaffected pregnancy. A patient with a positive test result should be referred for genetic counseling and should be offered invasive prenatal diagnosis for confirmation of test results.

Committee Opinion #546 “Tracking and Reminder Systems” (Revised)
ABSTRACT: An accurate and effective tracking or reminder system is useful for the modern practice of obstetrics and gynecology. Practices should not rely solely on the patient to complete all ordered studies and to follow up on health care provider recommendations. Health care providers should encourage their patients to complete studies believed essential for patient care within an acceptable time frame. Each office should establish a simple, reliable tracking and reminder system to facilitate communication, improve patient safety and quality of care, and minimize missed or delayed diagnoses.

Committee Opinion #547 “Health Care for Women in the Military and Women Veterans” (NEW!)
ABSTRACT: Military service is associated with unique risks to women’s reproductive health. As increasing numbers of women are serving in the military, and a greater proportion of United States Veterans are women, it is essential that obstetrician–-gynecologists are aware of and well prepared to address the unique health care needs of this demographic group. Obstetrician–-gynecologists should ask about women’s military service, know the Veteran status of their patients, and be aware of high prevalence problems (eg, posttraumatic stress disorder, intimate partner violence, and military sexual trauma) that can threaten the health and well-being of these women. Additional research examining the effect of military and Veteran status on reproductive health is needed to guide the care for this population. Moreover, partnerships between academic departments of obstetrics and gynecology and local branches of the Veterans Health Administration are encouraged as a means of optimizing the provision of comprehensive health care to this unique group of women.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization. www.acog.org

 

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