Table 1.
Site | Guideline content pertaining to DCC in very preterm birth | Guideline content pertaining to CM in very preterm birth | Reported practice of DCC | Reported practice of CM | Recommended duration DCC | Duration reported in practice | Specific instructions about execution of CM in guideline (number of milkings, length of cord, height of baby etc | Delivery into plastic bag prior to cord ligation mandated in guideline | Guideline exclusions | Comments |
---|---|---|---|---|---|---|---|---|---|---|
Site 1 Tertiary Hospital |
Presented as alternative options | Very few | All | None | 5–10 s | No | No | Most babies <28 weeks delivered by caesarean section had CM—more variability at higher gestations | ||
Site 2 tertiary hospital 6000–7000 deliveries |
Discouraged | Recommended | Few | ‘standard practice’ | NA | ? | Yes | Yes | CM seen as safer than DCC in all circumstances | |
Site 3 medium size district hospital 5000–6000 deliveries |
Recommended | Only if DCC seen as unsafe | 70% in recent audit | Minority | 30 s | 30s | No | No | None | DCC considered as part of resuscitation process |
Site 4 tertiary hospital 6000–7000 deliveries |
Nil | Nil | Minority | Minority | No recommendation | ? | No | No | DCC recommended for term births | |
Site 5 tertiary hospital |
Recommended | Nil | Majority <28 weeks | Few, if any | 45 s | 30 s | No | No | Need for immediate resuscitation. Absent cord pulsation, or cord incised. Placental separation. Concerns for health of mother |
|
Site 6 smaller district hospital 2000–3000 births |
Discouraged | Nil | Minority | Minority | Discouraged | 0–30 s | No | No | ‘The consensus paediatric view, therefore, is that DCC should not be practised routinely on preterm babies., Policy advised CM where DCC could not be achieved. |
|
Site 7 4000–5000 births tertiary hospital |
Nil | Nil | Minority | Minority | NA | 15–60 s | No | No | None |
CM, cord milking/stripping; DCC, deferred cord clamping.