Bibliographic information
GuidelineConsolidated guidelines for the prevention, diagnosis and treatment of postpartum haemorrhage
Year of Publication2025
Issuing InstitutionWorld Health Organization
Recommendation
New
Early umbilical cord clamping (less than 1 min after birth) is not recommended unless the neonate is asphyxiated and needs to be moved immediately for resuscitation
Not recommended
Notes and Remarks
- The evidence base for recommendation for the timing of cord clamping includes both vaginal and caesarean births. The GDG considers this recommendation to be equally important for caesarean sections.
- Delayed cord clamping (for 1–3 minutes) should be performed during the provision of essential newborn care. For essential newborn care and resuscitation, please refer to the WHO Guidelines on neonatal resuscitation (49).
- The recommendations for the timing of cord clamping apply equally to preterm and term births. The GDG considers the benefits of delayed clamping for infants born preterm to be particularly important (50).
- Some health professionals working in areas of high HIV prevalence have expressed concern regarding delayed cord clamping as part of management of the third stage of labour. These professionals are concerned that during placental separation, a partially detached placenta could be exposed to maternal blood and this could lead to a micro-transfusion of maternal blood to the baby. It has been demonstrated that the potential for mother-to-child transmission of HIV can take place at three different points in time: micro-transfusions of maternal blood to the fetus during pregnancy (intrauterine HIV transmission); exposure to maternal blood and vaginal secretions when the fetus passes through the birth canal in vaginal births (intrapartum transmission); and during breastfeeding (postnatal infection). For this reason, the main intervention to reduce mother-to-child transmission is the reduction of maternal viral load through the use of antiretroviral drugs during pregnancy, childbirth and the postnatal period. There is no evidence that delaying cord clamping increases the possibility of HIV transmission from the mother to the newborn. Maternal blood percolates through the placental intervillous space throughout pregnancy with a relatively low risk of maternal fetal transmission before birth. It is highly unlikely that separation of the placenta increases exposure to maternal blood, and it is highly unlikely that it disrupts the fetal placental circulation (i.e. it is unlikely that during placental separation the newborn circulation is exposed to maternal blood). Thus, the proven benefits of a 1–3 minute delay at least in clamping the cord outweigh the theoretical, and unproven harms. Late cord clamping is recommended even among women living with HIV or women with unknown HIV status.
- The understanding of the contribution of each component of the active management of the third stage of labour package has evolved in light of established evidence. The GDG reaffirmed that the primary intervention within this package is the use of a uterotonic. When oxytocin is administered, controlled cord traction may offer a small additional benefit, while uterine massage appears to offer no added value in preventing PPH. Early cord clamping remains generally contraindicated.