Maternal, Obstetric, and Neonatal Characteristics Associated with Delayed Cord Clamping

This study aimed to evaluate the factors associated with completed delayed cord clamping (DCC).

We conducted a retrospective review of viable singleton deliveries at a single academic medical center from January 1, 2020 to December 31, 2022. Demographics, obstetric variables, and neonatal data were extracted from the electronic medical record. Patients who received DCC were compared with those who did not. Multivariate logistic regression was used to assess factors associated with completion of 30 to 60 seconds of DCC, with a sub-analysis of preterm deliveries <30 weeks.

DCC was completed in 5,018/5,889 (85.2%) eligible deliveries. Lower DCC rates were observed among non-Black, White, or Asian patients versus White patients (82.1 vs. 87.1%; adjusted odds ratio [aOR] = 0.60, 95% CI: 0.47-0.78) and in 2020 versus 2022 (83.6 vs. 86.5%; aOR = 0.74, 95% CI: 0.61-0.91). Patients who completed DCC had lower mean BMI (32.59 vs. 34.53, aOR = 0.99, 95% CI: 0.98-0.996), were less likely to be nulliparous (83.9 vs. 86.4%, aOR = 0.78, 95% CI: 0.66-0.92), less likely to have pregestational diabetes (72.8 vs. 86.1%, aOR = 0.63, 95% CI: 0.45-0.87), chorioamnionitis (72.9 vs. 85.6%, aOR = 0.51, 95% CI: 0.36-0.73), or postpartum hemorrhage (73.0 vs. 85.6%, aOR = 0.59, 95% CI: 0.41-0.86). Preterm (68.5 vs. 87.8%, aOR = 0.50, 95% CI: 0.40-0.63) and cesarean deliveries (77.2 vs. 90.0%, aOR = 0.72, 95% CI: 0.60-0.85), and infants requiring resuscitation (61.7 vs. 91.6%; aOR = 0.20, 95% CI: 0.17-0.23) were less likely to have completed DCC. Among preterm newborns <30 weeks, neonatal resuscitation was the only factor associated with not receiving DCC after adjustment.

Race, delivery mode and year, maternal BMI, nulliparity, pregestational diabetes, chorioamnionitis, postpartum hemorrhage, preterm birth, and neonatal resuscitation were independently associated with completed DCC. Strategies to improve DCC execution should target preterm infants and address the challenges of performing DCC in neonates requiring urgent resuscitation.

· Preterm births are less likely to receive DCC.. · Infants requiring newborn resuscitation are less likely to receive DCC.. · DCC rates increased after the implementation of an institutional DCC policy..