Deferred cord clamping during term/late preterm cesarean section under general and regional anesthesia: a retrospective study.

To investigate the effects of anesthesia type and deferred umbilical cord clamping (DCC) on short-term maternal and neonatal outcomes at Cesarean section (CS). This single-center retrospective study of all CS ≥35 weeks from January 2018-December 2023 compared maternal and neonatal outcomes between deliveries with and without DCC ≥60 seconds (s) under general anesthesia (GA) versus regional anesthesia (RA). The cord was clamped earlier for maternal hemorrhage, placental separation, cord avulsion, or infant apnea after 30-60s. Multivariable generalized estimating equations were used to assess the independent and joint effects of anesthesia type and DCC on outcomes, adjusting for emergent CS, chorioamnionitis, and severe preeclampsia/eclampsia. 4341 mothers and 4463 infants were studied. DCC was performed in 62% (121/195) of GA and 87% (3728/4268) of RA infants. Interaction analyses demonstrated that the association between DCC and postpartum hemorrhage (PPH) differed by anesthesia type. Among mothers receiving GA, DCC ≥60s was not associated with PPH ≥1000 mL (50% vs 42%, p=.3) or transfusion (15% vs 16%, p=.8), whereas among RA mothers, DCC ≥60s was associated with lower adjusted probabilities of PPH (25% vs 48%, p<.001) and transfusion (5% vs 15%, p<.001). There was no significant interaction between DCC ≥60s and anesthesia type for neonatal outcomes. DCC ≥60s was associated with lower adjusted odds of 5-min APGAR <7 (OR 0.2 (0.2-0.4), p<.001), delivery room (DR) intubation (OR 0.0 (0.0-0.2), p<.001), umbilical artery pH < 7 (OR 0.5 (0.3-0.8), p=.007) and NICU admission (OR 0.5 (0.4-0.6), p<.001). Regardless of anesthesia type, DCC ≥60s was not associated with higher risks of PPH or transfusion among mothers; and was not associated with any detriment in short term neonatal outcomes. We suggest that GA deliveries can be safely considered eligible for DCC under a standardized institutional protocol with predefined exit criteria.