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Oral Concurrent Session 3 Clinical Obstetrics www.AJOG.org

ration, necrotizing enterocolitis, respiratory distress syndrome or in-traventricular hemorrhage) were collected using the fetuses-at-riskapproach. A moving average (death at specific day � deaths of daybefore and day after/3) was applied to correct for daily fluctuations.RESULTS: The final study population comprised 985.321 deliveries in

aucasians (89.2%), 94.664 in Mediterraneans (8.6%) and 24.879 de-iveries in Africans (2.3%). For Caucasian and Mediterranean womenhe period of delivery associated with the lowest cumulative risk oferinatal death was between 39�0 and 39�6 weeks. For Africanomen this nadir appears to start earlier around 38�2 weeks. The riskf antenatal stillbirth rises after 39�6 weeks in Mediterranean com-ared to Caucasian women. Remarkably, neonatal morbidity is in-reased along all weeks of gestation in African women when comparedo the other ethnicities (Figure).

CONCLUSION: The nadir of perinatal death in Caucasian and Mediter-ranean pregnancies is at 39 weeks, for African women already around38 weeks. The risk of neonatal morbidity is highest in African womenregardless of week of gestation. Ethnicity of the mother should betaken into account when making decisions about intervening in apregnancy or to wait.

S22 American Journal of Obstetrics & Gynecology Supplement to JANUARY 20

35 A randomized controlled trial of immediate versuselayed cord clamping in the preterm neonate

Andrew Elimian1, Jean Goodman2, Marilyn Escobedo3,ydia Nightingale2, Eric Knudtson2, Marvin Williams2

1New York Medical College-Westchester medical Center, Obstetrics andynecology, Valhalla, NY, 2University of Oklahoma Health Sciences Center,

Obstetrics and Gynecology, Oklahoma City, OK, 3University of Oklahomaealth Sciences Center, Pediatrics, Oklahoma City, OK

OBJECTIVE: The comparative risks and benefits of early versus delayedord clamping in the term and preterm neonate remains unclear. Thereterm neonate is particularly at risk for anemia and various neona-al morbidities and mortality. Our objective was to determine thehort term effects of delayed cord clamping of the umbilical cordnpreterm neonates.

STUDY DESIGN: We conducted a randomized controlled trial compar-ing immediate with delayed cord clamping among preterm neonatesborn between 24 weeks and 34 weeks gestation. Immediate (within 5seconds of birth) and delayed (30-35 seconds after birth) cord clamp-ing were compared for various outcome variables including initialneonatal hematocrit, need for blood transfusion, number and volumeof blood transfusions RDS, IVH, PVL, NEC and neonatal mortality.RESULTS: A total of 200 women were randomized; 99 to the delayedord clamp and 101 to the immediate group. The two groups wereimilar with respect to baseline characteristics. The mean gestationalge at delivery was 30.8�/�3.1 weeks in the delayed clamp groupompared to 30.7�/�2.8 weeks in the immediate group, P � 0.64.he number and volume of blood transfusions and the rate of variousdverse perinatal outcomes including RDS, IVH, PVL, NEC and neo-atalmorality did not differ significantly between the groups. How-ver the mean initial hemoglobin (17.4�/�2.5 versus 16.3�/�2.3/dL, P � 0.001) and hematocrit (51.3�/�7.3 versus 47.4�/�7.3,� 0.001) were significantly higher in the delayed clamp group.

6.4% (36/99) of neonates in the delayed cord clamp group wereiagnosed with anemia of prematurity compared to 47.5% (48/101)

n the immediate clamp group, P � 0.11).CONCLUSION: Delaying cord clamping for 30 seconds significantlyraises the initial hemoglobin/hematocrit among preterm neonates.Although no reduction in adverse perinatal outcomes was observed,studies utilizing increased duration of delay in cord clamping are

needed.

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