Delayed Cord Clamping Guidelines
NRP 7th Ed: Current evidence suggests that cord clamping should be delayed for at least 30 to 60
seconds for most vigorous term and preterm newborns. If placental circulation is not intact, such as after
a placental abruption, bleeding placenta previa, bleeding vasa previa, or cord avulsion, the cord should
be clamped immediately after birth. There is insufficient evidence to recommend an approach to cord
clamping for newborns who require resuscitation at birth.
Definition: Clamping the umbilical cord at 60 seconds of life, after the baby is delivered to allow for the
placental transfusion to take place.
Milking of the umbilical cord is not currently recommended due to a lack of data in
support of this practice. NRP does not support milking of the cord and HPMC will
not incorporate it into practice at this time.
Benefits: Increased circulating blood volume, decreased need for blood transfusion, increased iron load,
decrease high grade IVH in premature infants
Eligible patients:
• All term babies who are vigorous at birth or not anticipated to require immediate resuscitation at
birth.
– C-section and Vaginal deliveries
– Multiple gestation
• Premature babies in coordination with the NICU team.
– C-section and Vaginal deliveries
– Multiple gestation
Contraindications:
• Emergent delivery
– Fetal intolerance to labor
• Cases with interruption of the placental blood flow/oxygenation:
– Abruption
– Maternal hemorrhage (i.e. bleeding placenta previa)
– Vasa previa
– Active maternal seizure
– Tight nuchal cord
– Cord avulsion
• MSAF and baby is not vigorous
• Apnea or poor respiratory effort at birth
– no spontaneous respiration by 20 – 30 seconds
• Hydrops due to any underlying cause
• Recipient twin in twin to twin transfusion syndrome
