B (4:25)

Put a clamp on the umbilical cord super fast.

C (4:28)

So the first one is called immediate clamping, and that was done, hey, baby's out, and you gotta clamp it. Traditionally, that was done every 15 to 20 seconds between 15 to 20 seconds from birth because we didn't want to flood the child with too much volume. Isn't that crazy? Like, that was the thing we wanted to prevent delayed cord clamping. So we're gonna walk through this timeline because this changed in 2012. So the first strategy, of course, is immediate cord clamp. Now, if there's an immediate cord clamp, what would be option B?

B (4:55)

Rin waiting 30 seconds.

C (4:58)

So if there's immediate, it would be delayed. See the quality student that we have here? Yes. If it's not immediate, then it would be delayed. So here's the catch, because this is a big deal. The 30 seconds, guys. 30 seconds. No problem. No problem. As long as baby doesn't need immediate attention in recess. The question is, is it 30? Is it 60? The American College of Nurse Midwives, ACNM says, why don't you leave that joker till it stops pulsating, like, up to three minutes. That's another opt. It's probably a lot, especially since the majority of volume that goes to the child really peaks at around 30 to 60. And then after 60, it's kind of a no brainer. Very little is going through RIN, but you're right. All right, so RIN told us A, which is immediate within 20 seconds. B was delayed. C is a third option which has to do with how to move the blood quickly. What is that called?

B (5:48)

It's like milking the umbilical cord.

C (5:50)

That's it. Boom. All right, guys, so abc, we have option A, immediate, B is delayed, which is what we're talking about here. And then C is milking. So very quickly, guys, let's look at this timeline and then we're take a quick break and we're going to come back and give you the quick update from AAP that does not, does not totally agree with acog. Guys, this is a testimony. As Rin told us in the intro, not everybody has to agree and it's not necessarily disagreeing. It's just a different flavor of seasoning. Yes. Yeah. All right, so watch this. So in a quick timeline, this started in 2012 when ACOG had released a statement saying, you know what, maybe immediate isn't the best way to go. Let's do delayed cord clamp, dcc, delayed cord clamp only though, guys, for preterm infants, this was the most of the benefit was for the preemies under 37 weeks. Rin, four years after that, something changed. Tell us about it.

B (6:43)

Yeah. In 2016, ACOG then started recommending delaying umbilical cord clamping for all healthy infants, including term babies.

C (6:50)

Boom. So we leave from preterm now we go to term in just four years. Okay, I dig that. Now, oddly enough, just the way it happened again in another four years. ACOG now in December of 2020, releases committee opinion 814 again, delayed umbilical cord clamping after birth. And this one specifically said, hey, I'm good with 30 seconds. You don't have to do 60, it's fine. But 30 second should be just fine. Now we're at 2020, guys, we've done 2012, 2016, 2020. Rin, what happened in 2022?

B (7:24)

In 2022, ACOG recommended management of placental transfusion to neonates after delivery.

C (7:30)

Isn't that great? So now we got fancier. So now it's just not delayed cord clamp, which is what it is. Remember, we covered this. Guys, for those of you that hung out with us since 2022. We actually covered this because the title was now Management of placental transfusion. Yes. Yes. We're no longer doing delayed cord clamp. It is placental transfusion, which is fine. And again, we're not making fun of it, but this is the same reason they call a C section a vaginal bypass surgery. Oh, my gosh.

B (7:59)

I didn't know that.

C (8:00)

Yeah, guys, you gotta have fun with this. But it technically is true. We're not just delaying the cord clamp because we're delaying cord clamp. We're trying to have placental transfusion of blood to the child, which helps prevent, in preterm infants, ivh, necrotitis and enterocolitis. They have less need for blood transfusion. They have less over raw perinatal mortality for preterm infants. So that. That is true. That was in 2022 then, guys. Now let's jump to this year. Now here's where we're going to go. Very quickly now, we are in July, when this came out electronic ahead of print as an epub, officially just out in September. Now remember, we're doing this in December, guys. So this is just three months ago, September 2025, which we covered. ACOG releases, a clinical practice update. And. And Rin, what was that update called?

B (8:48)

An update to clinical guidance for Delayed Umbilical Cord Clamping after Birth in Preterm Neonates.

C (8:53)

Oh, boy. Rin, this came out in 2012, then in September of 2025. So now over a decade, you would think, can we figure this out? Surely we know how to do this right? Isn't that interesting? How many updates have we covered? We've covered five updates since 2012.

B (9:10)

Yeah, you'd think they'd have it figured out a decade and a half later.

C (9:13)

It's a good testimony. Guys, you're learning. If you're a medical student, you got to learn what you got to learn, Resident. You got to learn what you got to learn for the RRC Residency Review Commission as an Attending. That's why we do manual what? Moc maintenance and certification. Low on caffeine, guys. Maintenance of certification. Because things keep changing. So we're going to cover this one, because September of 2025, three months ago. There's two main wrecks here that now introduce the 62nd issue for a certain population. Not for everybody, Rin. And then what is our most recent, which happened a month after that through the aha. Guys, that's not even ob. That's the American Heart Association. But the aap, the Pediatric peeps, joined on and said, yeah, we're going to put our name on this. This happened one month after ACOGs. We're going to highlight these two. That's really the focus here. We've just been building this up. We're gonna highlight September's from ACOG and then October 2025's AAP guidance on delayed cord clamp. Read me the name of that 2025 guidance. Cause it's a big, juicy title. Yeah.

B (10:19)

So October 2025, American Heart association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

C (10:27)

Yeah. So if you notice, the title is not Delayed Core Clamp. It's not. It's about resuscitation. I mean, it talks about body temperature, talks about percentage of O catheter use. It's super broad. But of course, part of that is delayed corticlamp. All right, guys, so that's where we're going. We're going to get out of this intro here in just a minute. This is just our first section here. And then when we come back, I just want to give you the quick highlights. Rinn is going to tell you the difference between the September 2025 ACOG update just three months ago and then two months ago AAP's update that was shared with the American Heart Association. So me and Rin will be right back. Foreign, You're listening to the obgyn no spin podcast.

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C (12:21)

Everyone, you know that we typically do this either in studio, which is near our health science center, or, you know, it's our home studio because we've got a podcast area at home. I know, I know that there may be some ambient sound here. It doesn't matter because me and Rin are At the hospital or. Actually, Rin, where are we physically right now?

B (12:39)

We're in the student room.

C (12:40)

Yeah. And actually it's really neat, so I'm sure most places have it. It's a undergraduate. A ume Undergraduate medical education rule. Students have to have their own spot, man. It's pretty nice. I mean, there's study tables that their microwave, a coffee machine. Of course we have our little LED TV that they plug in into their laptop. It's a nice little study room, but there's a lot of echo. Yeah, yeah. She looked at me like. And. All right, so here we go. All right, guys, so look, here we go real quick. So this is the point is the take home is why are we doing this episode? About 30 seconds versus 60 seconds. And in the little break, I told Rin, you know, it seems minor when you're a child though. Put this in perspective, guys. 30 seconds when you're connected to a water hose that's still running full steam. That's a lot. So just to be clear right now, ACOG stance is 30 seconds or 60 seconds. You do you. It's going to be okay. You pick. But especially at term, it seems that 30 seconds is okay. Here's the change that Rin's going to walk through. When ACOG did the update to delay core clamping that came out in the summer, officially out in September of 2025. I want her to read you the two recs from the college because now we introduce the concept of 60 seconds. Here we go. Rand ticket.

B (13:58)

Okay, so important clarification. This recommendation is for preterm infants, so under 37 weeks. And they had two main recommendations. So I'm going to quote for you. For term newborns who do not require immediate resuscitation, umbilical cord management has been updated. For those infants. Deferred cord clamping for at least 60 seconds can result in improved hematologic indices and iron status compared to immediate cord clamping. Authors say for non vigorous term infants and late preterm infants 35 weeks or more, gestational age, intact cord milking may be reasonable when compared to immediate cord clamping. And for newborn infants born at less than 37 weeks of gestation who do not require immediate resuscitation, deferred cord clamping for at least 60 seconds is recommended.

C (14:38)

Okay, so two big issues here, guys. You all see this? So remember, acog, right? Now, if you're asked what does ACOG say about delayed cord clamping, your answer should be, well, at what GESTATIONAL age, term, they kind of leave it up to you. 30 seconds is fine. Or 60, but under 37 weeks, it really should be 60 seconds. With the allowance for cord milking at 28 weeks. For above, according to AAP, they say no, no, no for term, if they don't need recess, it should be at least the 60. It sounds minor and it's kind of a. It's not really. It's kind of a little pissy. But the point is we should have recs that agree. So ACOG says 30 or 60. AAP as of October of 2025 now says it really should be 60 seconds overall. So, guys, yesterday in the C section, we left it as. Yes, it's true. Just do the 60 seconds. That seems to be where we are going. Just like HPV is being used primarily for cervical cancer screening, getting away from cytology, that's the trend in that vibe. The trend in this vibe for neonatal care and umbilical cord management is the 62nd rule. So, Ran, we have covered from 2012 all the way up until October 2025. I mean, don't you think that's interesting?

B (15:55)

Yeah, I think it's really interesting. And it sounds like we're splitting hairs, but shouldn't we all agree?

C (15:59)

Yeah, and that's really it. And that's fair. Professional medical society. See things, interpret the same data, guys. Exact same data, maybe with a little different perspective. Super interesting. Rin. This was fantastic, y'. All. Podcast family. I literally just said, hey, come on, we're gonna come do this. And then she was a good sports and said, sure. So for her first national and international podcast. No, no pressure. You did great. And again, great job you're doing this year. Keep doing. You're killing it. And I guess we should get back to work.

B (16:29)

All right, thanks so much, Dr. Chapa.

C (16:30)

All right, podcast family, that brings us to a wrap. Michael, I know you. There's some weird audio on this thing. Please try to normalize that sound. And now that we've done all that, podcast family, let's take it home. Foreign. This has been Dr. Chapa Zobi Gyn, no Spin podcast Podcast family. Thank you for your support. Thank you for listening. And as always, we'll see you on another episode of the no Spin Podcast.