The edition · Obstetrics & Gynaecology
Cord milking for the floppy term baby, and steroids that may not help twins
A Canadian technical update makes room for intact cord milking when a baby of 35 weeks or more stays non-vigorous after stimulation. Twin data question routine antenatal steroids, and aspirin leaves a measurable residual risk of preterm pre-eclampsia.
The edition in brief
The Society of Obstetricians and Gynaecologists of Canada published a technical update (6 October 2026) on intact umbilical cord milking for non-vigorous infants at 35 weeks or more. If a baby remains non-vigorous after about 15 seconds of deferred clamping, warming and stimulation, milking the intact cord may be considered, with the aim of reducing moderate to severe hypoxic-ischaemic encephalopathy and the need for cardiorespiratory support. The evidence did not show a meaningful rise in jaundice needing phototherapy. A meta-analysis of 16 studies in twin pregnancies (18,367 neonates, mostly observational, June 2026) found no clear reduction in neonatal death (RR 0.77, 0.59-1.01) or respiratory distress syndrome (RR 1.11, 0.81-1.52) with antenatal corticosteroids, and more neonatal hypoglycaemia (RR 1.80) and unit admission (RR 1.33). Certainty was moderate to low and guidance has not changed. A secondary analysis of an Asian stepped-wedge trial of 2,919 high-risk women on aspirin found 3.7% still developed preterm pre-eclampsia; chronic hypertension, a raised mean arterial pressure and a very high first-trimester risk estimate (1 in 2 to 1 in 5) marked those who did. The pearl covers how to recognise and manage neonatal hypoglycaemia risk after late steroids.
Antenatal steroids in twins: no clear benefit, more hypoglycaemia
Do not drop steroids for twins, but be more selective about late-preterm courses and plan for neonatal glucose checks.
Who still gets preterm pre-eclampsia on aspirin
Women screened at very high risk still carry a real chance of preterm pre-eclampsia on aspirin; plan their surveillance accordingly.
Late-preterm steroids and the newborn's glucose
Any baby born after a late steroid course needs its exposure flagged and its glucose checked per protocol.
Intact cord milking for the non-vigorous baby at 35 weeks or more
For a non-vigorous baby at 35 weeks or more, intact cord milking is now a reasonable option to discuss in your unit's resuscitation protocol.
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