A Randomized Controlled Trial of Intact Cord Milking versus Immediate Cord Clamping in Term Infants Born by Elective Cesarean Section

Abstract

Objective We evaluated whether intact umbilical cord milking (UCM) is more effective than immediate cord clamping (ICC) in enhancing placental transfusion after elective cesarean delivery. Study Design In a randomized trial, volume of placental transfusion was assessed by Δ hematocrit (Hct) between neonatal cord blood and capillary heel blood at 48 hours of age, corrected for the change in body weight. Results There were no significant differences in cord blood mean Hct values at birth (UCM, 44.5 ± 4.8 vs. ICC, 44.9 ± 4.2%, p = 0.74). Conversely, at 48 hours of age, the UCM group had significantly higher capillary heel Hct values (UCM, 53.7 ± 5.9 vs. ICC, 49.8 ± 4.6%, p < 0.001), supporting a higher placental transfusion volume (Δ Hct, UCM 9.2 ± 5.2 vs. ICC 4.8 ± 4.7, p < 0.001), despite comparable neonatal body weight decrease (UCM, −7.3 vs. ICC, −6.8%, p = 0.77). Conclusion Higher Δ Hct between cord blood at birth and capillary heel blood at 48 hours of age, corrected for the change in body weight, suggests that intact UCM is an efficacious and safe procedure to enhance placental transfusion among neonates born via elective cesarean delivery. Clinical Trial Registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT03668782.

Effect of early and delayed umbilical cord clamping on placental transfusion in two-step delivery: a randomised clinical trial

“…Firstly, comparable Hct levels present in arterial cord blood gas analysis of neonate groups delivered via the two-step method may be a confounding factor to predict and quantify placental transfusion at birth. 17 Conversely, Δ Hct increase at 48 hours of life may be useful as a crude formula to quantify and compare neonatal placental transfusion magnitude in early and delayed cord clamping settings, accounting for body weight decrease. By including ∆ Hct and ∆ body weight from birth to 48 hours of age in relation to time of umbilical cord clamping, our study offers a crude formula to indirectly estimate placental transfusion as part of neonatal adaptation to extrauterine life.…”

“…As Hct is a sensitive indicator of haematological status at birth and has been shown to be an e cient indicator of third phase of labour management, assessment of the primary outcome, the magnitude of placental transfusion, was based on ∆ Hct at 48 hours after ECC or DCC. [17] A sample size of 74 participants (37 per arm) was calculated to have an 80% chance of detecting as signi cant, at the 0.05 level, a mean difference of 6% (with a standard deviation of 6%) in the primary outcome measure between the two arms. The sample size was increased to 90 subjects to take into account a possible dropout of 20%.…”

Umbilical Cord Management in Late Preterm and Term Infants: A Randomized Controlled Trial

“…In a randomized trial, the I-UCM group had significantly higher capillary heel Hct values at 48 hours of age when compared with the ICC group. 23 In another study, 24 women scheduled for elective cesarean section were randomized to either ICC (<10 seconds) or I-UCM. The obstetrician milked the entire length of the cord toward the infant five times before clamping.…”

Effects of cord milking in late preterm infants and full‐term infants: A systematic review and meta‐analysis

“…The selected studies were conducted in the United States, 26 India, [27][28][29][30][31][32] Egypt, 33,34 and Italy. 35 The sample size of the studies ranged from 24 to 300 newborns. UCM was compared with DCC in six RCTs 28,29,[31][32][33][34] and ICC in four RCTs.…”

“…UCM was compared with DCC in six RCTs 28,29,[31][32][33][34] and ICC in four RCTs. 26,27,30,35 One RCT 28 included DCC as control and DCC with milking the cut cord (DCM). In this case, to carry out the meta-analysis, we only included data on the UCM and DCC groups and excluded data on the DCM group.…”