***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective To investigate the effects of delayed umbilical cord clamping , compared with early clamping , on infant iron status at 4 months of age in a European setting . Design R and omised controlled trial . Setting Swedish county hospital . Participants 400 full term infants born after a low risk pregnancy . Intervention Infants were r and omised to  delayed umbilical cord clamping ( ≥180 seconds after delivery )  or early clamping ( ≤10 seconds after delivery ) . Main outcome measures Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels . Secondary outcomes included neonatal anaemia , early respiratory symptoms , polycythaemia , and need for phototherapy . Results At 4 months of age , infants showed no significant differences in haemoglobin concentration between the groups , but infants subjected to delayed cord clamping had 45 % ( 95 % confidence interval 23 % to 71 % ) higher mean ferritin concentration ( 117 μg/L v 81 μg/L , P<0.001 ) and a lower prevalence of iron deficiency ( 1 ( 0.6 % ) v 10 ( 5.7 % ) , P=0.01 , relative risk reduction 0.90 ; number needed to treat=20 ( 17 to 67 ) ) . As for secondary outcomes , the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age ( 2 ( 1.2 % ) v 10 ( 6.3 % ) , P=0.02 , relative risk reduction 0.80 , number needed to treat 20 ( 15 to 111 ) ) . There were no significant differences between groups in postnatal respiratory symptoms , polycythaemia , or hyperbilirubinaemia requiring phototherapy . Conclusions Delayed cord clamping , compared with early clamping , result ed in improved iron status and reduced prevalence of iron deficiency at 4 months of age , and reduced prevalence of neonatal anaemia , without demonstrable adverse effects . As iron deficiency in infants even without anaemia has been associated with impaired development , delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia . Trial registration Clinical Trials NCT01245296 Iron deficiency anemia is a serious health problem that affects the physical and cognitive development of children . Therefore , it is important to develop cost-effective interventions to improve the hematologic status of the millions of children affected by this condition worldwide . We studied 69 Guatemalan infants who had been r and omly assigned to one of three groups at the time of delivery : 1 ) cord clamping immediately after delivery ( n = 21 ) ; 2 ) clamping when the cord stopped pulsating , with the infant placed at the level of the placenta ( n = 26 ) ; or 3 ) clamping when the cord stopped pulsating , with the newborn placed below the level of the placenta ( n = 22 ) . Maternal and infant hematologic assessment s were performed at the time of delivery and 2 mo postpartum . At baseline the groups had similar socioeconomic , demographic , and biomedical characteristics and the newborns had similar hematocrit status . Two months after delivery , infants in the two groups with delayed cord clamping had significantly higher hematocrit values and hemoglobin concentrations than did those in the early-clamping group . The percentage with hematocrit values < 0.33 was 88 % in the control group compared with 42 % in group 2 and 55 % in group 3 ( P = 0.01 ) . These results suggest that waiting until the umbilical cord stops pulsating ( approximately 1 min after delivery ) is a feasible low-cost intervention that can reduce anemia in infants in developing countries Objective : The study 's objective was to compare hematocrit ( Hct ) levels at 36 to 48 h of age in term infants delivered by cesarean section exposed to immediate cord clamping or umbilical cord milking ( UCM ) .  Study Design : In this r and omized controlled trial , 24 women scheduled for elective cesarean section were r and omized to either immediate clamping ( < 10 s ) or UCM ( milked × 5 by the obstetrical provider ) at birth . Result : All subjects received their allocated intervention . The milking group had a smaller placental residual blood volume ( 13.2±5.6 vs 19.2±5.4 ml kg–1 , P=0.01 ) and higher Hct levels at 36 to 48 h ( 57.5±6.6 vs 50.0±6.4 % , P=0.01 ) . Five infants ( 42 % ) in the immediate group had a Hct of ⩽47 % , indicative of anemia . Conclusion : UCM results in placental transfusion in term infants at the time of elective cesarean section with higher Hct levels at 36 to 48 h of age A r and omised , controlled trial of 1429 women was carried out to compare ' active ' management of the third stage of labour , using i.v . Ergometrine 0.5 mg , with a method of ' physiological ' management , in women at ' low risk ' to haemorrhage . In the " active " management group a higher incidence of the following complications was found:- manual removal of placenta ( p less than 0.0005 ) , problems such as nausea ( p less than 0.0005 ) , vomiting ( p less than 0.0005 ) , and severe after-birth pains ( p less than 0.02 ) , hypertension ( p less than 0.0001 ) and secondary postpartum haemorrhage ( p less than 0.02 ) . The incidence of postpartum haemorrhage ( blood loss greater than 500 ml ) and postnatal haemoglobins less than 10 gm/100 were higher in the ' physiological ' group ( p less than 0.0005 , p less than 0.002 ) . No difference was found in the need for blood transfusion in either group . The routine use of i.v . Ergometrine 0.5 mg during the third stage of labour in women at ' low risk ' to haemorrhage does not appear to be necessary and has many adverse effects . Further studies comparing different methods of ' physiological ' management are recommended in order to reduce to a minimum the incidence of postpartum haemorrhage and anaemia This study investigated the effect of clamped and unclamped cord on third stage of labor in two patient groups and correlated the drained placental blood volume with the newborn hematocrit . In the first group ( trial group , n = 215 ) the placental part of the cord was left unclamped and the drained blood volume was measured . In the second group ( control group , n = 199 ) the placental part of the umbilical cord was left clamped . Both groups were nearly equal regarding history , age and parity . The following results were obtained : Unclamped umbilical cord was associated with a shorter third stage of labor , unclamped umbilical cord was associated with less blood loss during third stage of labor , unclamped umbilical cord was associated with fewer operative procedures ( i.e. manual removal of the placenta ) , differences regarding the number of incomplete or possibly incomplete placentae were not evident , a highly significant negative correlate was found between placental blood volume drained from the umbilical cord and newborn hematocrit ( r = 0.38 ; p less than 0.001 ) BACKGROUND This study tested the hypotheses that active management of the third stage of labour  lowers the rates of primary postpartum haemorrhage ( PPH ) and longer-term consequences compared with expectant management , in a setting where both managements are commonly practised , and that this effect is not mediated by maternal posture . BACKGROUND 1512 women judged to be at low risk of PPH ( blood loss > 500 mL ) were r and omly assigned active management of the third stage ( prophylactic oxytocic within 2 min of baby 's birth , immediate cutting and clamping of the cord , delivery of placenta by controlled cord traction or maternal effort ) or expectant management ( no prophylactic oxytocic , no cord clamping until pulsation ceased , delivery of placenta by maternal effort ) . Women were also r and omly assigned upright or supine posture . Analyses were by intention to treat . FINDINGS The rate of PPH was significantly lower with active than with expectant management ( 51 [ 6.8 % ] of 748 vs 126 [ 16.5 % ] of 764 ; relative risk 2.42 [ 95 % CI 1.78 - 3.30 ] , p<0.0001 ) . Posture had no effect on this risk ( upright 92 [ 12 % ] of 755 vs supine 85 [ 11 % ] of 757 ) . Objective measures of blood loss confirmed the results . There was more vomiting in the active group but no other important differences were detected . INTERPRETATION Active management of the third stage reduces the risk of PPH , whatever the woman 's posture , even when midwives are familiar with both approaches . We recommend that clinical guidelines in hospital setting s advocate active management ( with oxytocin alone ) . However , decisions about individual care should take into account the weights placed by pregnant women and their caregivers on blood loss compared with an intervention-free third stage OBJECTIVE --To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant ( physiological ) management , in particular to determine whether active management reduced incidence of postpartum haemorrhage . DESIGN --R and omised trial of active versus physiological management . Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery . Five months into trial high rate of postpartum haemorrhage in physiological group ( 16.5 % v 3.8 % ) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management . Sample size of 3900 was planned , but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped . SETTING --Maternity hospital . PARTICIPANTS --Of 4709 women delivered from 1 January 1986 to 31 January 1987 , 1695 were admitted to trial and allocated r and omly to physiological ( 849 ) or active ( 846 ) management . Reasons for exclusion were : refusal , antepartum haemorrhage , cardiac disease , breech presentation , multiple pregnancy , intrauterine death , and , after May 1986 , ritodrine given two hours before delivery , anticoagulant treatment , and any condition needing a particular management of third stage . INTERVENTIONS --All but six women allocated to active management actually received it , having prophylactic oxytocic , cord clamping before placental delivery , and cord traction ; whereas just under half those allocated to physiological management achieved it . A fifth of physiological group received prophylactic oxytocic , two fifths underwent cord traction and just over half clamping of the cord before placental delivery . ENDPOINT -- Reduction in incidence of postpartum haemorrhage from 7.5 % under physiological management to 5.0 % under active management . MEASUREMENTS AND MAIN RESULTS --Incidence of postpartum haemorrhage was 5.9 % in active management group and 17.9 % in physiological group ( odds ratio 3.13 ; 95 % confidence interval 2.3 to 4.2 ) , a contrast reflected in other indices of blood loss . In physiological group third stage was longer ( median 15 min v 5 min ) and more women needed therapeutic oxytocics ( 29.7 % v 6.4 % ) . Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups . Babies in physiological group weighed mean of 85 g more than those in active group . When women allocated to and receiving active management ( 840 ) were compared with those who actually received physiological management ( 403 ) active management still produced lower rate of postpartum haemorrhage ( odds ratio 2.4;95 % CI1.6 to 3.7 ) . CONCLUSIONS --Policy of active management practised in this trial reduces incidence of postpartum haemorrhage , shortens third stage , and results in reduced neonatal packed cell volume OBJECTIVES Our purpose was to compare the controlled cord traction technique with the minimal intervention technique for delivery of the placenta . The primary outcome was the incidence of postpartum hemorrhage . Secondary outcomes included duration of third stage of labor , frequency of retained placenta , hemorrhagic shock , the need for blood transfusion , and the need for uterotonic agents to control postpartum hemorrhage . STUDY DESIGN A total of 1648 women who were delivered vaginally were r and omly allocated during labor to the  controlled cord traction group ( n = 827 ) or the minimal intervention group ( n = 821 ) . In the controlled cord traction group women received oxytocin , 10 units intramuscularly , with delivery of the baby 's anterior shoulder , after which the placenta was delivered actively by controlled cord traction ( Br and t- And rews method ) . In the minimal intervention group the placenta was delivered by maternal pushing . Continuous intravenous oxytocin was given after delivery of the placenta . Odds ratios with 95 % confidence intervals were calculated for each variable . RESULTS The overall incidence of postpartum hemorrhage was significantly lower in the controlled cord traction group ( 5.8 % vs 1 
    Output:
    
There were no significant differences between subgroups depending on the use of uterotonic drugs .
A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted , particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants .