LAUSR

women (or neonates) undergoing cesarean delivery (CD), where the mean blood loss is twice that of a VD with the potential for increased bleeding from delayed hysterotomy closure. We performed a randomized trial to compare maternal blood loss with immediate cord clamping (ICC) versus delayed cord clamping (DCC) in term CD. STUDY DESIGN: Two-center, randomized clinical trial comparing maternal blood loss with ICC ( 15 sec after birth) versus DCC (60 sec after birth) in term CD (NCT03150641). Women undergoing scheduled CD of full term singleton gestations were eligible. Those with abnormal placentation, fetal anomalies, known fetal anemia, growth restriction with abnormal Dopplers, preeclampsia, significant maternal anemia, bleeding disorders, planned cord blood banking or refusal of blood products were excluded. Immediately before CD, women were randomized in a 1:1 ratio to ICC or DCC. The primary outcome was drop in maternal hemoglobin (Hgb) from pre-op to post-op day one. Secondary maternal outcomes included estimated blood loss, postpartum hemorrhage (>1000 mL), need for uterotonics and blood transfusion. Neonatal outcomes including Hgb at 24-72 hrs of life were assessed. Assuming a mean Hgb drop of 1.37 0.87 g/dL, with a hypothesized effect size of a 0.9 g/dL (1.25 SD) difference in the primary outcome between groups and anticipating 20% crossover, the required sample size (two-tailed a1⁄40.05, b1⁄40.1; 90% power) was 53 women per group. Analysis was based on intention-to-treat. RESULTS: From October 2017 February 2018, 113 women were randomized (56 to ICC; 57 to DCC). There was no difference in the primary outcome, with a mean drop in Hgb of 1.78 0.91 g/dL and 1.85 0.95 g/dL in the ICC and DCC groups (P1⁄40.69, Table 1). Maternal secondary outcomes were similar between groups. Neonatal Hgb data, available for 90 infants (79.6%), showed a higher Hgb with DCC compared to ICC (18.1 2.5 vs 16.4 1.9 g/dL; P <0.01; Table 2). CONCLUSION: In scheduled term CD, DCC is not associated with increased maternal blood loss but does achieve higher neonatal Hgb levels at 24-72 hrs of life.