Transition at birth and delayed cord clamping — branching viva

Station opening

Examiner: "A vigorous term newborn has just been delivered. Walk me through your cord management." [1]

Strong candidate (must-hit)

• Plans the cord strategy before delivery; receives the infant, dries and stimulates. [12]
• States deferred cord clamping for at least 60 seconds, skin-to-skin on the mother, cord at or below the infant. [12]
• Names the iron-store benefit as the rationale and the Cochrane evidence base. [1]

Weak candidate

• "Clamp immediately so we can weigh and examine the baby." [1]

Branch A — The jaundice question

Examiner: "The mother read online that delayed clamping causes jaundice. What do you tell her?" [1]

Strong

• Acknowledges a small rise in bilirubin and a small increase in phototherapy use. [1]
• States there is no significant rise in harmful hyperbilirubinaemia; the iron-store benefit outweighs the manageable jaundice cost. [1]
• Confirms deferred clamping does not increase maternal postpartum haemorrhage. [1]

Weak

• "Jaundice risk means we should clamp early." [1]

Branch B — The preterm delivery

Examiner: "Now a 26-week infant is coming. Your registrar suggests cord milking to speed the transfusion. What do you say?" [3]

Strong

• States milking is contraindicated under 28 weeks; cites the Katheria 2019 JAMA trial showing excess severe intraventricular haemorrhage. [3]
• Plans deferred clamping for at least 30 to 60 seconds with intact-cord stabilisation and aggressive warming. [2]
• Names the preterm benefits: fewer transfusions, less IVH, better stability. [2]

Weak

• "Milking is a good way to get the transfusion done quickly." [3]

Branch C — The non-vigorous infant

Examiner: "The 26-week infant is born limp and apnoeic. What now?" [12]

Strong

• Resuscitation takes priority over the cord plan; begins positive-pressure ventilation. [12]
• Offers intact-cord resuscitation at a bedside trolley if a trained team is ready, otherwise clamps and moves. [13]
• Escalates by heart rate only after effective ventilation. [12]

Weak

• "Keep waiting on the cord to finish the transfusion." [12]

Branch D — Intact-cord resuscitation and evidence

Examiner: "Explain how intact-cord resuscitation works and where the evidence is moving." [13]

Strong

• Describes the bedside trolley allowing warming, assessment and ventilation with the cord attached. [13]
• States the evidence for the preterm is building; uptake depends on equipment and team training. [13]
• Names the active questions: optimal duration of deferral, sustained inflation, starting oxygen for the preterm. [13]

Weak

• "Intact-cord resuscitation is proven superior in all infants." [13]

Close

Examiner: "Summarise your cord-management philosophy in one sentence." [12]

Strong

• "I plan before delivery, defer for at least 60 seconds in the term and 30 to 60 seconds in the preterm with active warming, never milk under 28 weeks, and resuscitate first whenever the infant is non-vigorous." [12] [3]