Neonatal Outcomes of Umbilical Cord Milking, Early Cord Clamping and Delayed Cord Clamping in Term Infants: A Randomised Controlled Trial.

Introduction Optimal umbilical cord management at birth plays a crucial role in neonatal outcomes. While delayed cord clamping (DCC) has been associated with improved neonatal haematologic and hemodynamic status, early cord clamping (ECC) remains widely practised. Umbilical cord milking (UCM) has emerged as an alternative to DCC, potentially offering similar benefits while reducing the delay in neonatal resuscitation. This study aims to compare the effects of UCM, ECC, and DCC on neonatal outcomes in term infants born between 37 and 42 weeks of gestation. Methods A total of 225 pregnant women at 37-42 weeks' gestation were randomised into three groups: ECC, UCM, and DCC. Participants delivered by spontaneous vaginal delivery or caesarean section. Newborn haemoglobin, haematocrit, and micro-bilirubin levels were measured within 48 to 72 hours of birth. Maternal demographic data, blood loss volume, newborn Apgar scores at 1 and 5 minutes, neonatal complications, phototherapy requirements, and hospital stay durations were recorded. Baseline maternal characteristics, including antenatal visit counts and haematocrit levels at 32-34 weeks, were similar across groups. Results All three groups of pregnant women had no difference in baseline characteristics, number of antenatal visits and baseline haematocrit in the first visit and during 32-34 weeks of gestation. Haemoglobin and haematocrit between the DCC group (17.35 g/dl (2.18), 48.38% (5.76)), the UCM group (17.34 g/dl (2.09), 48.09% (5.70)) and in the ECC group (16.27 g/dl (1.95), 44.92% (5.080)) were different with statistically significant. Other results, including estimated blood loss, neonatal bilirubin, the requirement of phototherapy, blood exchange and neonatal complications, were not different among the three groups. Conclusion UCM and DCC improve neonatal haematologic parameters compared to ECC, with DCC showing the greatest benefits. However, DCC is associated with a higher risk of neonatal jaundice requiring phototherapy. UCM may serve as a viable alternative when immediate resuscitation is needed. Further research is required to refine optimal cord management strategies.