Paeds Cases · fetal-neonatal-and-perinatal
Transition at birth and delayed cord clamping — structured clinical encounter
Structured encounter testing the preterm cord-management plan: deferral timing, the milking contraindication, thermoregulation, and intact-cord resuscitation for a 27-week infant.
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Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 27-week gestation infant is about to be delivered to a mother with preterm labour. You are the neonatal registrar preparing the cord-management plan with the team. A colleague proposes cord milking.
Station brief (candidate)
You are the neonatal registrar. A 27-week gestation infant is about to be delivered to a mother in preterm labour who received antenatal steroids. The obstetric team asks for your cord-management plan. A colleague on the team suggests cord milking to deliver the placental transfusion faster. You have 12 minutes with the team and 5 minutes for examiner discussion. [2]
References6ShowHide
- [2]Rabe H; Gyte GM; Díaz-Rossello JL; Duley L Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev, 2019.PMID 31529790
- [3]Katheria A; Reister F; Essers J; Mendler M Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA, 2019.PMID 31742630
- [5]Fogarty M; Osborn DA; Askie L; Seidler AL Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol, 2018.PMID 29097178
- [8]Mercer JS; Erickson-Owens DA; Vohr BR; et al Effects of Placental Transfusion on Neonatal and 18 Month Outcomes in Preterm Infants: A Randomized Controlled Trial. J Pediatr, 2016.PMID 26547399
- [12]Aziz K; Lee CHC; Escobedo MB; et al Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
- [13]Madar J; Roehr CC; Ainsworth S; et al European Resuscitation Council Guidelines 2021: Newborn resuscitation and support of transition of infants at birth. Resuscitation, 2021.PMID 33773829