Sustained Cord Circulation at Emergency Cesarean Section

NCT ID: NCT06540222

Last Updated: 2025-09-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

2200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-08

Study Completion Date

2031-11-30

Brief Summary

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The goal of this clinical trial is to evaluate if sustained cord circulation during resuscitation improves outcomes for term neonates born by emergency Cesarean section. The main question it aims to answer is: Does sustained cord circulation reduce admission rates to neonatal care?

Researchers will compare resuscitation with an uncut umblical cord to standard resuscitation practices to see if it provides better outcomes.

Participants (term neonates born by emergency Cesarean section) will:

Receive resuscitation with either sustained cord circulation or standard care Be monitored for admission to neonatal care and other predefined health outcomes

Detailed Description

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Study Title

Sustained Cord Circulation During Resuscitation of Non-Breathing Neonates Born by Cesarean Section: A Multicenter Randomized Controlled Trial

Primary Objectives:

To compare neonatal outcomes between two different approaches to resuscitation of term neonates born by CS; Intact cord resuscitation versus standard care with immediate cord clamping, and evaluate:

A composite outcome of admission to neonatal care for predefined criteria or death before admission. Predefined criteria include asphyxia at birth, respiratory distress, hypoxic ischemic encephalopathy (HIE) and hypoglycemia. Assessed within one week after birth.

Secondary Objectives: Secondary outcomes will include short and long-term neonatal outcomes, adverse maternal and neonatal outcomes, and caregivers' and staff's experiences.

Study Design: A multicenter, stepped-wedge cluster randomized trial.

Study Population: Singleton neonate born alive, gestational age ≥37 weeks, born by emergency cesarean section, epidural/spinal anesthesia. Pediatric team summoned before birth due to health concerns regarding the neonate.

Intervention: Resuscitation with intact cord circulation during 3-5 minutes. When in need of respiratory support, the neonate will be kept close to the mother with the cord intact and the placenta attached to the uterine wall. The pediatric team will give respiratory support with sustained cord circulation, following Swedish neonatal CPR guidelines. Cord clamping will be performed after respiration has been established and at the earliest after three minutes. Cord clamping will be performed at the latest at 5 minutes.

Control: Resuscitation will be performed after the cord was cut. When in need of respiratory support, the cord will be clamped immediately, and the neonate will be taken to an adjacent place for resuscitation according to Swedish neonatal CPR guidelines. Well neonates will have their cord clamped after 1 minute in accordance with national recommendations.

Power analysis: At a significant level of 0.05, the power to detect the anticipated risk reduction (15%) would be 0.88 (two-sided).

Study Duration 2025-2028

Conditions

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Asphyxia Neonatorum Fetal Hypoxia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Multicenter, stepped-wedge cluster randomized trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Intact cord

The neonate will be kept close to the mother with the cord intact. When in need of ventilatory support, the neonatal team will give ventilatory support with an unclamped umbilical cord, following neonatal cardiopulmonary resuscitation guidelines. Cord clamping will be performed after respiration has been established and at the earliest after three minutes and not later than five minutes.

Group Type EXPERIMENTAL

Sustained cord (≥ 180 seconds) resuscitation

Intervention Type PROCEDURE

Resuscitation performed in near proximity to the mother with umbilical cord uncut

Standard care

Management according to standard care, including immediate cord clamping for neonates requiring ventilatory support. In cases where ventilatory support is not necessary, cord clamping will be performed within 60 seconds of birth, adhering to established clinical guidelines for neonatal management.

Group Type ACTIVE_COMPARATOR

Routine (< 60 seconds) cord clamping

Intervention Type PROCEDURE

Resuscitation performed at a designated area after umbilical cord is cut

Interventions

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Sustained cord (≥ 180 seconds) resuscitation

Resuscitation performed in near proximity to the mother with umbilical cord uncut

Intervention Type PROCEDURE

Routine (< 60 seconds) cord clamping

Resuscitation performed at a designated area after umbilical cord is cut

Intervention Type PROCEDURE

Other Intervention Names

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Intact cord resuscitation Delayed cord clamping Immediate clamping

Eligibility Criteria

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Inclusion Criteria

* Singleton neonate
* Born alive
* Gestational age ≥37 weeks
* Born by emergency cesarean section, epidural/spinal anesthesia, where the pediatric/neonatal team has been called for to attend.

Exclusion Criteria

* Major congenital malformation that may affect resuscitation or outcome measures.
* Major genetic disorder that may affect resuscitation or outcome measures.
Minimum Eligible Age

37 Weeks

Maximum Eligible Age

42 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Region Stockholm

OTHER_GOV

Sponsor Role collaborator

Region Skane

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ola Andersson, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Region Skåne, Lund University

Jenny Svedenkrans, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Karolinska University Hospital, Karolinska Institutet

Locations

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Östra sjukhuset - Sahlgrenska Universitetssjukhuset

Gothenburg, , Sweden

Site Status RECRUITING

Hallands sjukhus, Halmstad

Halmstad, , Sweden

Site Status RECRUITING

Universitetssjukhuset i Linköping

Linköping, , Sweden

Site Status RECRUITING

Skånes Universitetssjukhus

Lund, , Sweden

Site Status RECRUITING

Skånes Universitetssjukhus, Malmö

Malmo, , Sweden

Site Status RECRUITING

Universitetssjukhuset Örebro

Örebro, , Sweden

Site Status RECRUITING

BB Stockholm

Stockholm, , Sweden

Site Status RECRUITING

Danderyds sjukhus

Stockholm, , Sweden

Site Status RECRUITING

Karolinska Universitetssjukhuset, Huddinge

Stockholm, , Sweden

Site Status RECRUITING

Karolinska Universitetssjukhuset, Solna

Stockholm, , Sweden

Site Status RECRUITING

Södersjukhuset - Sachsska barn- och ungdomssjukhuset

Stockholm, , Sweden

Site Status RECRUITING

Norrlands universitetssjukhus

Umeå, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Ola Andersson, MD PhD

Role: CONTACT

‭+46 70-966 41 80

Jenny Svedenkrans, MD PhD

Role: CONTACT

‭+46 72-469 86 60

Facility Contacts

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Anders Elfvin

Role: primary

+46 31-342 10 00

Verena Sengpiel

Role: backup

Anna Kasemo

Role: primary

+4635131000

Elisabeth Olhager

Role: primary

046-171000

Elisabeth Olhager

Role: primary

040-331000

References

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Ekelof K, Saether E, Andersson O, Svedenkrans J, Linden K. pre-SUCCECS: Lessons learned from implementing resuscitation and stabilisation with an intact cord during caesarean sections - Focus group discussions with implementation teams. Sex Reprod Healthc. 2025 Sep;45:101114. doi: 10.1016/j.srhc.2025.101114. Epub 2025 May 26.

Reference Type BACKGROUND
PMID: 40479951 (View on PubMed)

Alikhani VS, Thies-Lagergren L, Svedenkrans J, Elfvin A, Bolk J, Andersson O. Stabilisation and resuscitation with intact cord circulation is feasible using a wide variety of approaches; a scoping review. Acta Paediatr. 2023 Dec;112(12):2468-2477. doi: 10.1111/apa.16985. Epub 2023 Sep 28.

Reference Type BACKGROUND
PMID: 37767916 (View on PubMed)

Related Links

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https://www.succecs.se/

Homepage of the SUCCECS study (in Swedish)

Other Identifiers

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Dnr 2024-00276-01

Identifier Type: OTHER

Identifier Source: secondary_id

SUCCECS

Identifier Type: -

Identifier Source: org_study_id

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