Immediate Versus Delayed Cord Clamping in Management of Placenta Accreta Spectrum: Secondary Analysis of Multicenter International Study

Objective: To compare maternal and neonatal outcomes of immediate versus delayed cord clamping in women with placenta accreta spectrum (PAS).   Study Design: PAS-ID is an international retrospective multicenter database originating from 11 centers (9 countries), which included women with confirmed PAS between January 1st, 2010 and December 31st, 2019. Women were considered eligible to this study if diagnosis of PAS was confirmed, women were adequately followed ante- and postpartum. Women with intrauterine fetal death were excluded. Primary outcome was massive PAS-associated perioperative blood loss (intraoperative blood loss ≥ 2500 ml, bleeding associated massive transfusion protocol, or complicated by disseminated intravascular coagulopathy). Secondary outcomes include 1-minute, 5-minute APGAR scores, and admission to neonatal intensive care unit (NICU). Multivariable logistic regression was used for analysis and results were presented as adjusted odds ratios (aOR) and 95% confidence interval (CI). Results: Out of 797 women, 716 met our inclusion criteria. Of these women, 120 underwent delayed cord clamping (16.76%). After adjustment for potential confounders, delayed cord clamping was associated with lower risk of massive blood loss (aOR 0.26, 95% CI 0.11 – 0.63) and admission to NICU (aOR 0.45, 95% CI 0.29 - 0.87). It was not associated with lower risk of 1 minute APGAR < 7 (aOR 1.88, 95% CI 0.92 - 3.85) or 5-minute APGAR < 7 (aOR 0.67, 95% CI 0.21 - 2.10). Conclusion: Delayed cord clamping does not seem to increase risk of PAS-associated massive blood loss. However, maternal, and neonatal stability should be considered before a decision can be made. Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained in each contributing center from their receptive institutional review board before the study was conducted. This includes Aswan University, Egypt (Ethics Committee on Feb 11th, 2020, reference N; Aswu/439/2/20), Inonu University (reference number: 2020/476, dated 3/3/2020), Yuzuncu yil University (reference number: 55163642-100-E.36909, dated 09/06/2020), and Ege University (reference number: 20-4.1 T/3, dated 14/4/2020) in Turkey, Fatima memorial hospital/College of Medicine, and Dentistry, Pakistan (reference number: FMH-03-2020-IRB747-M, dated 5/12/2020), Kazan State University, Russia (reference number: 1765, dated 30/6/2020), Centro Hospitalar Sao Joao, Portugal (reference number: 76/2020, dated 21/5/2020), National Taiwan University College of Medicine, Taiwan (reference number: 202003007RINC, dated 30/3/2020), Faculty of Medicine of University of Yaounde I, Cameroon (reference numbers: 1019/CIERSH/DM/2020, dated 25/2/2020). Both Peking University Shenzhen Hospital and Universitas Padjadjaran Bandung were waived for the minimal risk per their local hospital policies. All data were anonymized and authorized for use before submission for analysis.