International Journal of Clinical Obstetrics and Gynaecology

Background: Umbilical cord management during the immediate postnatal period plays a crucial role in determining neonatal hematological and metabolic outcomes. While early cord clamping (ECC) has been traditionally practiced, delayed cord clamping (DCC) and umbilical cord milking (UCM) have gained attention for their potential benefits in improving neonatal hemoglobin levels and iron stores. However, comparative evidence regarding these techniques in term infants delivered by cesarean section remains limited.

Objectives: To compare the effects of immediate cord clamping, delayed cord clamping, and umbilical cord milking on neonatal hemoglobin levels at birth and on Day 3 of life, and to assess their impact on serum bilirubin levels in term infants delivered by cesarean section.

Methods: This prospective analytical study was conducted at SMGS Hospital, Government Medical College, Jammu, over one year (May 2024-April 2025). A total of 144 term neonates delivered by cesarean section were enrolled and allocated into three groups: umbilical cord milking (Group 1), delayed cord clamping for 30-180 seconds (Group 2), and early cord clamping (Group 3). Hemoglobin levels were measured at birth and on Day 3, while serum bilirubin levels were assessed at the same time points. Statistical analysis was performed using ANOVA with post-hoc testing, and a p-value <0.05 was considered significant.

Results: Baseline maternal and neonatal characteristics were comparable across groups. Neonates in the DCC and UCM groups demonstrated significantly higher hemoglobin levels at birth compared to the ECC group (p<0.001). By Day 3, the DCC group maintained the highest hemoglobin levels and was the only group showing a positive rise in hemoglobin. Serum bilirubin levels at birth and Day 3 were significantly lower in the DCC group compared to ECC, with UCM showing intermediate values. DCC was associated with the smallest rise in bilirubin levels over time.

Conclusion: Delayed cord clamping demonstrated superior and sustained hematological benefits with a favorable bilirubin profile in term cesarean-delivered neonates. These findings support DCC as the preferred umbilical cord management strategy to optimize early neonatal outcomes.