Effects of umbilical cord milking compared to differed cord clamping in term infants, a randomized controlled trial

Abstract

Introduction: Differed cord clamping (DCC) at delivery is currently recommended to increase neonatal haemoglobin levels (Hb) and reduce the risk of infant anemia. It needs waiting for two to three minutes, which is considered to be associated with most of its unwanted effects. An alternative could be umbilical cord milking (UCM) with early clamping. Although effects of UCM have been assessed in preterm neonates such evidence is sparse for term neonates. Objectives: To evaluate whether the effects on Hb, bilirubin and haemodynamic parameters in infants, and blood loss in the mother are better with UCM than with DCC during elective caesarean delivery at term. Methods: Sixty term pregnant mothers undergoing elective caesarean delivery (CD) in Teaching Hospital Kandy, from 1st February to 31st March 2015 were randomized to UCM and DCC. The UCM group had the umbilical cord milked towards the umbilicus of the baby in a standard method soon after delivery. The DCC group had the umbilical cord clamped after two minutes of delivery or once the cord pulsations had ceased. Neonatal Hb, bilirubin and haemodynamic parameters, and maternal blood loss were assessed within 48 hours of delivery. Results: Thirty three participants underwent UCM while 27 participants underwent DCC. Main indications for the CD were past CD (47%), failed induction (12%), past bad obstetric history (10%), maternal medical conditions (8%) and suspected gross cephalo pelvic disproportion (8%). All CD were performed under spinal aneasthesia. There were no significant differences between the UCM and DCC groups with regard to mean neonatal Hb (17.6g/dl, sd 2.0 vs 17.4g/dl, sd 2.4, p=0.67), mean neonatal total bilirubin (111.8 mmol/l, sd 47.6 vs 123.0mmol/l, sd 35.0, p=0.69) and mean maternal decrease in Hb (1.0g/dl, sd 0.7 vs 1.3g/dl, sd 1.0, p=0.37). All the neonates had birth APGAR of 10 at 5 minutes. The volume of blood remaining in the placenta was significantly higher in the UCM group (29.5ml, sd 20.3 vs 19.5ml, sd 13.1, p=0.03). Conclusions: Neonatal and maternal outcomes are not better with UCM than with DCC during elective CD.