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. 2019 Sep 17;2019(9):CD003248. doi: 10.1002/14651858.CD003248.pub4

Dipak 2017.

Methods Randomised controlled trial using variable blocks of 3 and 6
Participants Inclusion criteria
  • Mothers at 27 to 316/7 weeks' gestation

  • Singleton pregnancies

  • N = 78 women and babies


Exclusion criteria
  • Births > 32 weeks' gestation; multiple births, Rh‐ve status, placenta previa or abruption‐placenta, and those having fetus with major congenital anomalies, hydrops, fetal growth restriction with abnormal Doppler waveforms, or evidence of fetal distress.

Interventions Intervention 1: DCC
  • Cord clamped at 60 secs

  • Neonates were held in a pre‐warmed towel approximately 10‐15 inches below the introitus at vaginal delivery/below the level of placental incision in caesarean delivery.

  • N = 26 babies


Intervention 2: DCC + IM ergometrine to mother
  • Cord clamped at 60 secs

  • Neonates were held 10‐15 inches below the introitus at vaginal birth/below the level of placental incision in CS.

  • Injection ergometrine 500 μg intramuscular (IM) was administered to the mother.

  • N = 25 babies


We pooled data from Interventions 1 and 2.
Comparator: ECC
  • Cord clamped within 10 secs

  • Baby was held supine at level of introitus/placental incision.

  • N = 27 babies


Additional information
  • Gestational subgroup: < 32‐34 weeks' gestation

  • Resuscitation with cord intact: not available

  • Access to NICU: yes

  • Length of delay: about 60 secs

  • Baby placed: no information

  • Uterotonic: no information

  • UCM: n/a


Comparison 1
DCC with neonatal resuscitation after cord clamping vs ECC (subgroup by gestation)
Subgroup 1: < 32‐34 weeks' gestation
Comparison 4
DCC with neonatal resuscitation after cord clamping vs ECC (subgroup by type intervention)
Subgroup 4: DCC at 1‐2 mins with baby low (+ gravity)
Outcomes Primary outcome
  • Hct at 4 hrs of age


Secondary outcomes
  • Temperature on admission

  • Heart rate

  • NIBP at 12 hrs

  • Urinary output for initial 72 hrs

  • Number of red cell transfusions

  • Total serum bilirubin (TSB) at 72 hrs

  • Peak serum bilirubin (PSB)

  • Evidence of RoP, IVH

  • LOS, N

  • NEC stage 2 or more

Notes Setting: tertiary care hospital, Mumbai, India
Dates: October 2012 to September 2013
Declaration of interest: no competing interests reported
Trial funding source: Quote: "None".
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: “…random number sequence with variable block size of 3 or 6 using a ‘Random Allocation Software’ program... The random allocation sequence was generated by a statistician who was not a part of the study.”
Allocation concealment (selection bias) Low risk Quote: “The sequence was concealed in serially numbered, opaque, sealed and identical envelopes.”
Blinding of participants and personnel (performance bias) 
 All outcomes High risk It was not possible to blind clinicians.
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk There is no information regarding blinding of outcome assessments. The laboratory data could have been blinded but it is unclear about clinical outcomes.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Data reported as complete
Selective reporting (reporting bias) Unclear risk We did not assess trial protocol
Other bias Unclear risk No other biases apparent but not really clear.