Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Umbilical Cord Milking on Hemodynamic Status of Preterm Infants: a Randomized Controlled Trial
Brief Summary: Very preterm babies frequently develop problems with their blood circulation during the first few days after birth. These circulation problems could affect the oxygen and blood flow to their brain and lead to effects such as bleeding in the head or delayed developmental milestones later in life. Currently the care for such problems may include transfusion of intravenous fluids or blood to the baby and/or giving the baby medications that can help circulation.

The current practice at the delivery of these babies is to immediately clamp their umbilical cords after birth. Recent research studies have shown that giving more of the baby's own blood to them at birth by delayed cord clamping (waiting for clamping the cord for about 30-90 seconds) or by milking the cord, may reduce the number of blood transfusions that these babies may need later on. It may also improve their initial blood pressure and reduce the chances of bleeding in their heads.

More research is needed to prove if either delayed cord clamping or milking the cord at birth will be better in terms of improving these babies' health.

The aim of this study is to find out if adding some blood to these babies' circulation, through milking the cord at birth, could prevent or reduce the possible problems with blood circulation and the reduced blood flow to the brain that some of these babies may have after birth.

The investigators will also investigate if milking the cord at birth could improve their long-term developmental outcome.

Hypothesis: In preterm infants less than 31 weeks' gestation, milking the umbilical cord 3 times prior to clamping, compared to immediate clamping after birth will improve systemic blood flow (as assessed by improving superior vena cava flow measured by heart ultrasound in the first 24 hours after birth)


Options:
A: Inclusion Criteria:

* Singleton pregnancies
* Signed consent to participate in the trial

Exclusion Criteria:

* Major fetal anomaly or known fetal chromosomal abnormalities
* Multiple gestation
* Mothers with pregestational and gestational diabetes
* Refusal to participate in the trial
B: Inclusion Criteria:

* Pregnant women delivering at study site hospital

Exclusion Criteria:

* Delivery by Cesarean section
* Pregnancy ≤ 36 or ≥ 42 weeks gestation
* Multiple gestation
* Diagnosis of any of the following in the current pregnancy: hemorrhage requiring clinic/hospital admission, placental abnormalities, fetal anomalies, Down's syndrome of the fetus
* Diagnosis of pre-eclampsia or eclampsia in current or previous pregnancies
* Diagnosis at any time for the mother of any of the following: Diabetes, hypertension, cardiopathies, chronic renal disease
* Infant with major congenital malformation
* Infant birth weight less than 2500 g
* Mother not planning to breast feed for at least 6 months
* Mother smoked during current pregnancy
* Unwilling to return for follow-up study visits at the hospital
C: Inclusion Criteria:

* Pregnant women between 24 and 31.6 weeks gestation at risk of delivery
* Vaginal or cesarean birth

Exclusion Criteria:

* Congenital anomaly
* Multiple gestation
* Intent to withhold or withdraw care
* Severe or multiple maternal illnesses
* Mothers who are institutionalized or psychotic
D: Inclusion Criteria:Preterm infants \< 31 weeks' gestation if their mothers fulfill the following inclusion criteria:

1. admitted to the hospital for at least 2 hours before delivery in preterm labor (cervical dilatation \>2 cm or having premature rupture of membranes) or if a decision to induce labour has been made by treating physician for a maternal or fetal indications).
2. at 24+0 weeks - 30+6/7 weeks gestation (by best estimate based on date of last menstrual period or early ultrasound)

Exclusion Criteria:

1. monochorionic twin or any higher order multiple pregnancy
2. major fetal congenital or chromosomal anomalies
3. significant placental abruption
4. fetal anemia/transfusion
5. Rh isoimmunization
6. intent to withhold or withdraw treatment of the infant

Answer: D