Effect of antenatal administration of magnesium sulphate and milking of umbilical cord during delivery on the incidence of intraventricular haemorrhage in preterm infants

Stephy Maria Tom, V. C. Manoj


Background: Intraventricular hemorrhage (IVH) is commonly seen in preterm infants. The aim of this study was to look at the effect of antenatal magnesium sulphate administration and milking of umbilical cord during delivery in the incidence of IVH in preterm infants.

Methods: A randomized controlled study was conducted in the year 2015 on 80 preterm infants born less than 33 weeks of gestation during the study period. Magnesium sulphate was administrated to 25 pregnant women who were at imminent risk for delivery. Fourteen infants underwent milking of umbilical cord. The primary outcome was IVH detected in cranial ultrasound of day 28.

Results: The primary outcome showed only 1 infant who received magnesium sulphate developed IVH, whereas 3 infants with no intervention done developed IVH. None of the preterm infants who had undergone milking of umbilical cord developed IVH.

Conclusions: It was found that both antenatal administration of magnesium sulphate and milking of umbilical cord during delivery in preterm infants resulted in a significant reduction in the incidence of IVH. Further studies using more number of samples are required to understand the role of the interventions for long-term implications.


Antenatal magnesium sulphate, Intraventricular hemorrhage, Preterm infants, Milking of the cord

Full Text:



Kuban KC, Leviton A, Pagano M, Fenton T, Strassfeld R, Wolff M. Maternal toxemia is associated with reduced incidence of germinal matrix hemorrhage in premature babies. J Child Neurol. 1992;7(1):70-6.

Paneth N, Jetton J, Pinto-Martin J, Susser M. Magnesium sulfate in labor and risk of neonatal brain lesions and cerebral palsy in low birth weight infants. Pediatr. 1997;99(5).

Crowther CA, Middleton PF, Wilkinson D, Ashwood P, Haslam R. Magnesium sulphate at 30 to 34 weeks’ gestational age: neuroprotection trial (MAGENTA)-study protocol. BMC Pregnancy Childbirth. 2013;13(1):91.

Doyle LW, Crowther CA, Middleton P, Marret S. Antenatal magnesium sulphate and neurologic outcome in preterm infants: a systematic review. Obstet Gynecol. 2009;113(6):1327-33.

Manoj VC. Randomized controlled trial of antenatal magnesium sulphate for short term neuroprotection in premature neonates. Indian J Child Health. 2017;4(2):199-202.

Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Directorate of Strategy and Clinical Care, Health Service Executive. Clinical practice guideline. Antenatal magnesium sulphate for neuroprotection. 2013;1(23). Available at

Rouse DJ, Hirtz DG, Thom E, Varner MW, Spong CY, Mercer BM, et al. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. New Eng J Med. 2008;359(9):895-905.

Doyle LW, Crowther CA, Middleton P, Marret S, Rouse D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev. 2009;1(1).

Rabe H, Diaz‐Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. 2012;8(8).

Padbury JF. Placental Transfusion In: Rudolph’s Pediatrics. McGraw Hill Medical: New York, NY, USA; 2003:163-4.

Rabe H, Reynolds G, Diaz-Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatol. 2008;93(2):138-44.

Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatr. 2006;117(4):1235-42.

Mercer JS, Vohr BR, Erickson-Owens DA, Padbury JF, Oh W. Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. J Perinatol. 2010;30(1):11.

Brune T, Garritsen H, Witteler R, Schlake A, Wüllenweber J, Louwen F, et al. Autologous placental blood transfusion for the therapy of anaemic neonates. Neonatol. 2002;81(4):236-43.

Aladangady N, McHugh S, Aitchison TC, Wardrop CA, Holland BM. Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatr. 2006;117(1):93-8.

Rabe H, Jewison A, Alvarez RF, Crook D, Stilton D, Bradley R, et al. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol. 2011;117(2):205-11.

Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D, et al. Effect of umbilical cord milking in term and near-term infants: randomized control trial. Am J Obstet Gynecol. 2013;208(2):120-e1.

Lakshmi MS, Namboodiripad A, Manoj VC. Efficacy of milking of the cord on the neurodevelopmental outcome of preterm babies. J Evolution Med Dent Sci. 2018;7(10):1185-8.