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Results A pathway for submission to NIHR HTA was agreed, as the usual research led call would require pilot sites to continue for 18 months. In view of the timescales, full trial preparation continued in parallel with grant submission. The full stage application was rejected, and the pilot trial therefore closed. A closure plan was agreed with sponsor and TSC, to allow sites to either close immediately, or to randomise women who had given consent if they remained eligible. Recruitment and compliance were maintained during phase 2. Conclusions When an external pilot trial is successful, transforming it into an internal pilot by continuing into the full trial may maximise efficiency and value for money, but is a challenge to achieve.

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When an external pilot is successful, should it be possible to transform it into an internal pilot by continuing recruitment into the full trial is ready? A case study of the cord pilot trial