Maternal care
What is the best time to clamp the cord in relation to administration of uterotonic drugs in active management of the second stage of labor? How best to optimize cord clamping time in cases of maternal hemorrhage? Should the cord-clamping time be different in women positive for HIV?
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Resuscitation
How to consistently maintain the infant’s position in relation to placenta, especially in cesarean deliveries? Can we carryout resuscitation with the umbilical cord still attached to the undelivered placenta? How to record the timing of birth, and timing of various steps of neonatal resuscitation, including the recording of the Apgar scores?
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Cord Clamping
How long a delay is ideal? 30 seconds? 60 seconds? Or other durations depending upon the infant condition? What should be the location of baby while clamping the cord in relation to the placenta in cesarean sections? Should one document the exact time of cord clamping in all births? Up to what lower gestational age, benefits from delayed cord clamping can be demonstrated?
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Clamping versus Milking of the cord?
Are there differential benefits between milking and delayed clamping? What is the appropriate length of the cord to be milked? How “fast” and how many times milking is appropriate?
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At Risk Infants
What should be the standard for cord clamping in births at high altitudes? What should be done in infants with a risk for fetal polycythemia (e.g., severe intra uterine growth restriction, infant of diabetic mothers, large and small for gestational age)
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Guidelines and education
Need for developing standardized protocols Continued monitoring of outcomes for collective learning Periodic reassessment of guidelines
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