Cord pilot trial, comparing alternative policies for timing of cord clamping before 32 weeks gestation

follow-up for women up to one year

Lucy E. Bradshaw, Alexandra Sawyer, Lindsay Armstrong-Buisseret, Eleanor J. Mitchell, Susan Ayers, Lelia Duley

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The Cord Pilot Trial compared two alternative policies for cord clamping at very preterm birth at eight UK maternity units: clamping after at least 2 min and immediate neonatal care (if needed) with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports follow-up of the women by two self-completed questionnaires up to one year after the birth. Methods: Women were given or posted the first questionnaire between four and eight weeks after birth, usually before their baby was discharged, and were posted a second similar questionnaire at one year. The questionnaire included the Hospital Anxiety and Depression Scale; the Preterm Birth Experience and Satisfaction Scale (P-BESS) and questions about their baby's feeding. Results: Of 261 women randomised (132 clamping ≥2 min, 129 clamping ≤20 s), six were excluded as birth was after 35 + 6 weeks (2, 4 in each group respectively). Six were not sent either questionnaire. The first questionnaire was given/sent to 244 and returned by 186 (76%) (79, 74%). The second, at one year, was sent to 242 and returned by 133 (55%) (66, 43%). On the first questionnaire, 89 (49%) had a score suggestive of an anxiety disorder, and 55 (30%) had a score suggestive of depression. Satisfaction with care at birth was high: median total P-BESS score 77 [interquartile range 68 to 84] (scale 17 to 85). There was no clear difference in anxiety, depression, or satisfaction with care between the two allocated groups. The median number of weeks after birth women breastfed/expressed was 16 (95% confidence interval (CI) 13 to 20, n = 119) for those allocated clamping ≥2 min and 12 (95% CI 11 to 16, n = 103) for those allocated clamping ≤20 s. Conclusions: The response rate was higher for the earlier questionnaire than at one year. A high proportion of women reported symptoms of anxiety or depression, however there were no clear differences between the allocated groups. Most women reported that they had breastfed or expressed milk and those allocated deferred cord clamping reported continuing this for slightly longer. Trial registration: ISRCTN 21456601, registered 28th February 2013, http://www.isrctn.com/ISRCTN21456601

Original languageEnglish
Article number78
JournalBMC Pregnancy and Childbirth
Volume19
Issue number1
DOIs
Publication statusPublished - 21 Feb 2019

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Constriction
Pregnancy
Parturition
Premature Birth
Depression
Anxiety
Confidence Intervals
Surveys and Questionnaires
Anxiety Disorders
Milk

Keywords

  • Clinical trial
  • Follow up for women
  • Neonatal care with cord intact
  • Preterm birth
  • Umbilical cord clamping

Cite this

Bradshaw, Lucy E. ; Sawyer, Alexandra ; Armstrong-Buisseret, Lindsay ; Mitchell, Eleanor J. ; Ayers, Susan ; Duley, Lelia. / Cord pilot trial, comparing alternative policies for timing of cord clamping before 32 weeks gestation : follow-up for women up to one year. In: BMC Pregnancy and Childbirth. 2019 ; Vol. 19, No. 1.
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abstract = "Background: The Cord Pilot Trial compared two alternative policies for cord clamping at very preterm birth at eight UK maternity units: clamping after at least 2 min and immediate neonatal care (if needed) with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports follow-up of the women by two self-completed questionnaires up to one year after the birth. Methods: Women were given or posted the first questionnaire between four and eight weeks after birth, usually before their baby was discharged, and were posted a second similar questionnaire at one year. The questionnaire included the Hospital Anxiety and Depression Scale; the Preterm Birth Experience and Satisfaction Scale (P-BESS) and questions about their baby's feeding. Results: Of 261 women randomised (132 clamping ≥2 min, 129 clamping ≤20 s), six were excluded as birth was after 35 + 6 weeks (2, 4 in each group respectively). Six were not sent either questionnaire. The first questionnaire was given/sent to 244 and returned by 186 (76{\%}) (79, 74{\%}). The second, at one year, was sent to 242 and returned by 133 (55{\%}) (66, 43{\%}). On the first questionnaire, 89 (49{\%}) had a score suggestive of an anxiety disorder, and 55 (30{\%}) had a score suggestive of depression. Satisfaction with care at birth was high: median total P-BESS score 77 [interquartile range 68 to 84] (scale 17 to 85). There was no clear difference in anxiety, depression, or satisfaction with care between the two allocated groups. The median number of weeks after birth women breastfed/expressed was 16 (95{\%} confidence interval (CI) 13 to 20, n = 119) for those allocated clamping ≥2 min and 12 (95{\%} CI 11 to 16, n = 103) for those allocated clamping ≤20 s. Conclusions: The response rate was higher for the earlier questionnaire than at one year. A high proportion of women reported symptoms of anxiety or depression, however there were no clear differences between the allocated groups. Most women reported that they had breastfed or expressed milk and those allocated deferred cord clamping reported continuing this for slightly longer. Trial registration: ISRCTN 21456601, registered 28th February 2013, http://www.isrctn.com/ISRCTN21456601",
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Cord pilot trial, comparing alternative policies for timing of cord clamping before 32 weeks gestation : follow-up for women up to one year. / Bradshaw, Lucy E.; Sawyer, Alexandra; Armstrong-Buisseret, Lindsay; Mitchell, Eleanor J.; Ayers, Susan; Duley, Lelia.

In: BMC Pregnancy and Childbirth, Vol. 19, No. 1, 78, 21.02.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Cord pilot trial, comparing alternative policies for timing of cord clamping before 32 weeks gestation

T2 - follow-up for women up to one year

AU - Bradshaw, Lucy E.

AU - Sawyer, Alexandra

AU - Armstrong-Buisseret, Lindsay

AU - Mitchell, Eleanor J.

AU - Ayers, Susan

AU - Duley, Lelia

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N2 - Background: The Cord Pilot Trial compared two alternative policies for cord clamping at very preterm birth at eight UK maternity units: clamping after at least 2 min and immediate neonatal care (if needed) with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports follow-up of the women by two self-completed questionnaires up to one year after the birth. Methods: Women were given or posted the first questionnaire between four and eight weeks after birth, usually before their baby was discharged, and were posted a second similar questionnaire at one year. The questionnaire included the Hospital Anxiety and Depression Scale; the Preterm Birth Experience and Satisfaction Scale (P-BESS) and questions about their baby's feeding. Results: Of 261 women randomised (132 clamping ≥2 min, 129 clamping ≤20 s), six were excluded as birth was after 35 + 6 weeks (2, 4 in each group respectively). Six were not sent either questionnaire. The first questionnaire was given/sent to 244 and returned by 186 (76%) (79, 74%). The second, at one year, was sent to 242 and returned by 133 (55%) (66, 43%). On the first questionnaire, 89 (49%) had a score suggestive of an anxiety disorder, and 55 (30%) had a score suggestive of depression. Satisfaction with care at birth was high: median total P-BESS score 77 [interquartile range 68 to 84] (scale 17 to 85). There was no clear difference in anxiety, depression, or satisfaction with care between the two allocated groups. The median number of weeks after birth women breastfed/expressed was 16 (95% confidence interval (CI) 13 to 20, n = 119) for those allocated clamping ≥2 min and 12 (95% CI 11 to 16, n = 103) for those allocated clamping ≤20 s. Conclusions: The response rate was higher for the earlier questionnaire than at one year. A high proportion of women reported symptoms of anxiety or depression, however there were no clear differences between the allocated groups. Most women reported that they had breastfed or expressed milk and those allocated deferred cord clamping reported continuing this for slightly longer. Trial registration: ISRCTN 21456601, registered 28th February 2013, http://www.isrctn.com/ISRCTN21456601

AB - Background: The Cord Pilot Trial compared two alternative policies for cord clamping at very preterm birth at eight UK maternity units: clamping after at least 2 min and immediate neonatal care (if needed) with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports follow-up of the women by two self-completed questionnaires up to one year after the birth. Methods: Women were given or posted the first questionnaire between four and eight weeks after birth, usually before their baby was discharged, and were posted a second similar questionnaire at one year. The questionnaire included the Hospital Anxiety and Depression Scale; the Preterm Birth Experience and Satisfaction Scale (P-BESS) and questions about their baby's feeding. Results: Of 261 women randomised (132 clamping ≥2 min, 129 clamping ≤20 s), six were excluded as birth was after 35 + 6 weeks (2, 4 in each group respectively). Six were not sent either questionnaire. The first questionnaire was given/sent to 244 and returned by 186 (76%) (79, 74%). The second, at one year, was sent to 242 and returned by 133 (55%) (66, 43%). On the first questionnaire, 89 (49%) had a score suggestive of an anxiety disorder, and 55 (30%) had a score suggestive of depression. Satisfaction with care at birth was high: median total P-BESS score 77 [interquartile range 68 to 84] (scale 17 to 85). There was no clear difference in anxiety, depression, or satisfaction with care between the two allocated groups. The median number of weeks after birth women breastfed/expressed was 16 (95% confidence interval (CI) 13 to 20, n = 119) for those allocated clamping ≥2 min and 12 (95% CI 11 to 16, n = 103) for those allocated clamping ≤20 s. Conclusions: The response rate was higher for the earlier questionnaire than at one year. A high proportion of women reported symptoms of anxiety or depression, however there were no clear differences between the allocated groups. Most women reported that they had breastfed or expressed milk and those allocated deferred cord clamping reported continuing this for slightly longer. Trial registration: ISRCTN 21456601, registered 28th February 2013, http://www.isrctn.com/ISRCTN21456601

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KW - Follow up for women

KW - Neonatal care with cord intact

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