Milking Compared With Delayed Cord Clamping to Increase Placental Transfusion in Preterm Neonates: A Randomized Controlled Trial

Rabe, Heike MD, PhD; Jewison, Amanda MBBS; Fernandez Alvarez, Ramon MD; Crook, David PhD; Stilton, Denise RCN; Bradley, Robert MBBS; Holden, Desmond MBBS, PhD; for the Brighton Perinatal Study Group

doi: 10.1097/AOG.0b013e3181fe46ff
Original Research
Journal Club

OBJECTIVE: To compare two strategies to enhance placento-fetal blood transfusion in preterm neonates before 33 weeks of gestation.

METHODS: We recruited women at risk for singleton preterm deliveries. All delivered before 33 completed weeks of gestation. In this single-center trial, women were randomized to either standard treatment (clamping the cord for 30 seconds after delivery) or repeated (four times) milking of the cord toward the neonate. Exclusion criteria included inadequate time to obtain consent before delivery, known congenital abnormalities of the fetus, Rhesus sensitization, or fetal hydrops.

RESULTS: Of 58 neonates included the trial, 31 were randomized to cord clamping and 27 were randomized to repeated milking of the cord. Mean birth weight was 1,263±428 g in the clamping group and 1,235±468 g in the milking group, with mean gestational age of 29.2±2.3 weeks and 29.5±2.7 weeks, respectively. Mean hemoglobin values for each group at 1 hour after birth were 17.3 g/L for clamping and 17.5 g/L for milking (P=.71). There was no significant difference in number of neonates undergoing transfusion (clamping group, 15; milking group, 17; P=.40) or the median number of transfusions within the first 42 days of life (median [range]: clamping group 0 [0–7]; milking group 0 [0–20]; P=.76).

CONCLUSION: Milking the cord four times achieved a similar amount of placento-fetal blood transfusion compared with delaying clamping the cord for 30 seconds.

CLINICAL TRIAL REGISTRATION: National Research Register UK,, N0051177741.


Milking the umbilical cord four times to enhance placento-fetal transfusion is equally as effective as waiting for 30 seconds before clamping the cord in preterm neonates.

From the Brighton and Sussex University Hospitals, Department of Neonatology, Brighton, United Kingdom; the Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom; and the Brighton and Sussex University Hospitals, Department of Obstetrics, Brighton, United Kingdom.

See related editorial on page 203.

*For a list of members of the Brighton Perinatal Study Group, see the Appendix online at

Funded by a grant from the Brighton and Sussex University Hospitals Research and Development Directorate.

The authors thank all parents who consented to enrolling their neonates into the study, and Sue Clayton, clinical librarian, for her help with literature searches.

Corresponding author: Dr. Heike Rabe, Department of Neonatology, Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom; e-mail:

Financial Disclosure The authors did not disclose any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.