Review Article

Milking of the Umbilical Cord in Term and Late Preterm Infants

Table 1


AuthorType of the studyNumber of infantsInterventionsPrimary outcomesResults

Erickson-Owens, 2012Randomized controlled trial24 in term (>37 weeks of gestation) infants delivered by elective CSUCM: 12 
ICC: 12
Hct levels at 36 to 48 h of age exposed to ICC or UCMhigher Hct levels at 36 to 48 h of age in UCM group

Upadhyay, 2013Randomized controlled trial200 term and near-term infants (≥35 weeks of gestation)C-UCM: 100 
ICC: 100
Hb and serum ferritin at 6 weeks of postnatal ageMean Hb (11.9 [1.5] g/dL and mean serum ferritin 355.9 [182.6] μg/L) significantly higher in the C-UCM group Vs. ICC group (10.8 [0.9] g/dL and 177.5 [135.8] μg/L), respectively, at 6 weeks of age

Jaiswal, 2015
PMID: 25800496
Randomized controlled trial200 term infants (>36 weeks of gestation)C-UCM: 100 
DCC: 100
Serum ferritin and Hb at 6 weeks of lifeMean serum ferritin (134.0 ng/ml [89.8]) and mean hemoglobin (11.0 gm/dl [2.4]) in C-UCM group was comparable to mean serum ferritin (142.7 ng/ml [87.1]) and hemoglobin (11.3 gm/dl [2.6]) in DCC group at 6 weeks of age

Jaiswal, 2015
PMID: 26008758
Randomized controlled trial200 term infants (>36 weeks of gestation)C-UCM: 100 
DCC: 100
RI, PI and cerebral blood flow velocities of MCA at 24 to 48h of lifeMean PI [1.18 (0.26)] and RI [0.65 (0.08)] in UCM group was comparable to mean PI [1.18 (0.25)] and RI [0.65 (0.08)] in DCC group. The peak systolic velocity and end diastolic velocity (cm/s) of blood flow in MCA for UCM group were 34.94 (11.82) and 11.71 (4.75) respectively, while in DCC group they were 37.24 (12.63) and 13.07 (4.78) (p 0.23 and 0.07) respectively

Bora, 2015Randomized controlled trialInfants of non-anemic mothers (≥37 weeks of gestation): 90 
Infants of anemic mothers: 89
Infants of non-anemic mothers: ICC 45 
C-UCM 45 
Infants of anemic mothers: ICC 44 
C-UCM 45
Hb and serum ferritin concentrations at 6 months of ageMean Hb concentration at 6 months was 9.60±1.42 g dl(-1) in the C-UCM group and 9.07±1.10 g dl(-1) in the ICC (P=0.004). Mean serum-ferritin concentration at 6 months was 113.9±43.8 ng ml(-1) in the C-UCM group and 70.8±39.5 ng/ml in the ICC (P<0.001)

Yadav, 2015Randomized controlled trial300 neonates (≥37 weeks of gestation)UCM: 100 
DCC: 100 
DCM: 100
Hb and serum ferritin at 6 weeks of ageMedian serum 
ferritin at 6 weeks was significantly higher in the DCM group (295.49 (233.5 to 346.54) ng ml− 1) Vs. UCM group (184.55 (131.22 to 256.5) 
ng ml− 1) or only DCC (268.8 (189.4 to 315.44) ng ml− 1).

Agarwal, 2016Follow-up study of a 
randomized controlled trial
161 (≥37 weeks of gestation)UCM: 83 
DCC: 78
Hb and serum ferritin concentrations at 12 months of ageThe mean Hb in the DCC group (102.2 (17.2) g/L and serum ferritin 16.44 (2.77) μg/L) showed no significant differences to the UCM group (98.6 (17.1) g/L and 18.2 (2.8) μg/L) at one year

Katheria, 2018Retrospective analysis157 infants with abnormal cord gases (≥35 weeks of gestation)UCM: 36 
ICC: 121
neonatal outcomes during hospitalizationFewer infants in the UCM group needed resuscitation (38 vs. 56%, p = 0.07) and ongoing respiratory support (19 vs. 31%, p = 0.16) compared to the ICC

McAdams, 2018Clinical comparative study60 women ≥37 weeks’ gestationI-UCM:
15 3x Milkings 
15 4x Milkings 
C-UCM:
10 Cut10cm, 
10 Cut20cm 
10 Cut30cm
Placental transfusion blood volumesMean blood volume with I-UCM (×4) was increased compared to the 30 cm C-UCM technique (48.5 ± 19.0 vs. 24.8 ± 4.0 mL, P < 0.001). For C-UCM, blood volume increased proportionally to cord length and, by the second milking, 98.1 ± 4.5% of blood volume was delivered.

Alzaree, 2018Randomized controlled trial250 (≥ 37 weeks’ gestation)DCC: 125 
UCM: 125
Infant's Hb at 6 weeks after deliveryThere was a significant statistical difference between cases delivered by UCM and those delivered by a DCC in Hb after 6 weeks

Girish, 2018Quasi-randomized, non-blinded, controlled trial101 infants (≥35 weeks) who were depressed at birthNO UCM:51 
UCM: 50
Feasibility and safety of UCMNo significant differences in resuscitation delay, resuscitation efforts, and short-term outcomes between the two groups.

Hct= haematocrit.
Hb= haemoglobin.
CS= cesarean section.
RI= resistive index.
PI= pulsatility index.
MCA= middle cerebral artery.
UCM= umbilical cord milking.
DCC= delayed cord clamping.
DCM= DCC with milking the cut cord.