Delayed umbilical cord clamping

Waiting before clamping and cutting the umbilical cord after birth. In the large trial recorded here, which enrolled babies expected to be born before 30 weeks, waiting at least 60 seconds did not lower the chance of death or serious complications compared with clamping within 10 seconds.

Also called Delayed cord clamping · Late cord clamping

Intervention
In this atlas

Overview

Technical summary

The Australian Placental Transfusion Study (NEJM 2017) randomised fetuses of women expected to deliver before 30 weeks to clamping within 10 seconds or at least 60 seconds after delivery. The combined outcome of death or major morbidity by 36 weeks was 37.0% with delayed clamping and 37.2% with immediate clamping (relative risk 1.00, 95% CI 0.88 to 1.13). PREMOD2 (JAMA 2019) compared cord milking with delayed clamping; its safety signal belongs to cord milking and sits on the PREMOD2 record. This atlas holds no evidence for term babies.

About this intervention

Type: Procedure
Mechanism: Not reported

Claims and evidence

Context Infants born before 30 weeks of gestation (APTS trial)

Recipient: Newborn
Population: Fetuses of women expected to deliver before 30 weeks of gestation, randomised before birth. Of 1634 fetuses randomised, 1566 were born alive before 30 weeks and are the infants analysed.
Care setting: Not stated in the abstract. The trial registry named in the abstract is the Australian and New Zealand Clinical Trials Registry.
Geography: Not stated in the abstract (the registry named is Australian and New Zealand).
Life stage: Preterm infants born before 30 weeks of gestation; the intervention is the timing of cord clamping at delivery
Gestational age: up to 29 weeks 6 days (209 days), measured at birth
Postnatal age: Not reported
Follow-up: Death or major morbidity by 36 weeks of postmenstrual age; complete data on the primary outcome were available for 1497 infants (95.6%).

Eligibility: 1 inclusion criterion; exclusion criteria not stated

Included: Women expected to deliver before 30 weeks of gestation
Excluded: None stated

Effect Interventional Certainty not assessed

In the Australian Placental Transfusion Study, delayed cord clamping (at least 60 seconds after delivery) did not lower the combined outcome of death or major morbidity by 36 weeks in babies expected before 30 weeks, compared with immediate clamping (within 10 seconds): 37.0% against 37.2%, relative risk 1.00 (95% CI 0.88 to 1.13). Death alone was 6.4% against 9.0% (P=0.03 in unadjusted analyses and P=0.39 after post hoc adjustment for multiple secondary outcomes).
Applies to Newborn
- Fetuses of women expected to deliver before 30 weeks of gestation, randomised before birth. Of 1634 fetuses randomised, 1566 were born alive before 30 weeks and are the infants analysed.
- Not stated in the abstract. The trial registry named in the abstract is the Australian and New Zealand Clinical Trials Registry.
- Not stated in the abstract (the registry named is Australian and New Zealand).
- Preterm infants born before 30 weeks of gestation; the intervention is the timing of cord clamping at delivery
- Gestational age up to 29 weeks 6 days, measured at birth
- Postnatal age Not reported
Follow-up Death or major morbidity by 36 weeks of postmenstrual age; complete data on the primary outcome were available for 1497 infants (95.6%).
Certainty method
Not assessed

Limitations
The trial enrolled only babies expected before 30 weeks, so the result does not apply to term or later preterm babies. The mortality difference was not significant after adjustment for multiple secondary outcomes. The median time to clamping was 5 seconds and 60 seconds in the two groups. Only the abstract was read.

Last checked
Not recorded

Next evidence check due
Not scheduled
Sources and citations (4)
1. Supports Delayed versus Immediate Cord Clamping in Preterm Infants
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2017-12-21 · DOI: 10.1056/NEJMoa1711281 · PMID: 29081267
  
  Locator
  Abstract, RESULTS, sentences 4 and 5
  
  How it applies
  Primary composite and mortality results.
  
  Retrieved
  2026-10-14T18:23:59Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  63d68b276d531757a1d6b4012ae50d47d000230fe5d3b088479b312c3c54a36e
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
2. Background Delayed versus Immediate Cord Clamping in Preterm Infants
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2017-12-21 · DOI: 10.1056/NEJMoa1711281 · PMID: 29081267
  
  Locator
  Abstract, METHODS, sentences 1 and 2
  
  How it applies
  Randomisation and primary outcome definition.
  
  Retrieved
  2026-10-14T18:23:59Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  63d68b276d531757a1d6b4012ae50d47d000230fe5d3b088479b312c3c54a36e
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
3. Background Delayed versus Immediate Cord Clamping in Preterm Infants
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2017-12-21 · DOI: 10.1056/NEJMoa1711281 · PMID: 29081267
  
  Locator
  Abstract, RESULTS, sentences 1 and 2
  
  How it applies
  Number randomised and born alive, and timing achieved.
  
  Retrieved
  2026-10-14T18:23:59Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  63d68b276d531757a1d6b4012ae50d47d000230fe5d3b088479b312c3c54a36e
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.
4. Background Delayed versus Immediate Cord Clamping in Preterm Infants
  
  Publication · The New England journal of medicine · Edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched. · Published 2017-12-21 · DOI: 10.1056/NEJMoa1711281 · PMID: 29081267
  
  Locator
  Abstract, CONCLUSIONS, sentence 1
  
  How it applies
  The authors' conclusion.
  
  Retrieved
  2026-10-14T18:23:59Z
  
  Source effective date
  Not reported
  
  Source state
  Current
  
  Snapshot hash
  63d68b276d531757a1d6b4012ae50d47d000230fe5d3b088479b312c3c54a36e
  
  Reuse basis
  PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (https://pubmed.ncbi.nlm.nih.gov/disclaimer/). Short factual quotations under 25 words, with the citation.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Claim, not a settled fact APTS result in infants born before 30 weeks: Preterm birth (Evaluated for)
Applies to Newborn
- Fetuses of women expected to deliver before 30 weeks of gestation, randomised before birth. Of 1634 fetuses randomised, 1566 were born alive before 30 weeks and are the infants analysed.
- Not stated in the abstract. The trial registry named in the abstract is the Australian and New Zealand Clinical Trials Registry.
- Not stated in the abstract (the registry named is Australian and New Zealand).
- Preterm infants born before 30 weeks of gestation; the intervention is the timing of cord clamping at delivery
- Gestational age up to 29 weeks 6 days, measured at birth
- Postnatal age Not reported
Follow-up Death or major morbidity by 36 weeks of postmenstrual age; complete data on the primary outcome were available for 1497 infants (95.6%).
In the Australian Placental Transfusion Study, delayed cord clamping (at least 60 seconds after delivery) did not lower the combined outcome of death or major morbidity by 36 weeks in babies expected before 30 weeks, compared with immediate clamping (within 10 seconds): 37.0% against 37.2%, relative risk 1.00 (95% CI 0.88 to 1.13). Death alone was 6.4% against 9.0% (P=0.03 in unadjusted analyses and P=0.39 after post hoc adjustment for multiple secondary outcomes).
Limitations. The trial enrolled only babies expected before 30 weeks, so the result does not apply to term or later preterm babies. The mortality difference was not significant after adjustment for multiple secondary outcomes. The median time to clamping was 5 seconds and 60 seconds in the two groups. Only the abstract was read.

Record details

Record id: maternal:delayed-cord-clamping
Content hash: f5f88bb96b8ac831165599d70da0a9cad605545c3d321f7e5e52b6fb3a2dd58a