Umbilical Cord Milking on the Reduction of Red Blood Cell Transfusion Rates in Infants

The proposed design is a randomized controlled trial. Pregnant women at risk for delivering a singleton preterm infant between 24 and 28 weeks gestation will be randomized prior to delivery into one of two treatment arms. Common reasons for needing to be delivered at this early gestational age include but are not limited to: preterm labor not responding to tocolytic medications, incompetent cervix with cervical dilation and no contractions, clinical chorioamnionitis requiring delivery for maternal/fetal benefit, severe preeclampsia, severe growth restriction with a non-reassuring fetal heart rate tracing. The first arm will include active milking of the umbilical cord toward the neonate's umbilicus prior to cord clamping at delivery while the second arm will not include this intervention and will have their respective cord immediately clamped in the usual fashion post delivery (control).

Inclusion criteria

• Singleton pregnancy
• Delivery anticipated between 24 and 28+6 weeks gestation
• There is enough time from admission to anticipated delivery to properly obtain consent from the patient

Exclusion criteria

• Multifetal gestation
• Antenatally diagnosed major congenital anomaly
• Known Rh sensitized pregnancy
• Hydrops fetalis (any etiology)
• Known positive maternal Parvovirus titers
• Elevated peak systolic velocity of the fetal Middle Cerebral Artery (MCA)
• Clinical suspicion of placental abruption at delivery due to excessive maternal bleeding or uterine hypertonicity
• Maternal age under 18