1. Overburdened and Undernourished, Angelika Bord, MD, Yatel, Valsky, Dept. of OB/GYN, Hadassah-hebrew Univ. Med center, Jerusalem, Israel, www.AJOG.org (full article available), Sept. 2007.

Cord obstruction, signs of severe, IUGR (growth restriction), and nuchal cord (around the neck 4 times) resulting in heart decelerations, baby delivered early but alive.

2. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth, Mana Parast, MD, PhD, Crum, Boyd, Hbrigham and Women’s Hospital and Harvard Medical School, Human Pathology, Vol. 39, Issue 6, pages 948-953, 2008.

Summary: “Fatal hypoxic injury due to restriction of umbilical blood flow (‘cord accident’) may be causal in a subset of unexplained late pregnancy stillbirths. Minimal histologic criteria’ suggestive of cord accident were defined as a vascular ectasia and thrombosis within the umbilical cord, chorionic plate, and/or stem villi…Thus, we find nonacute cord compression implicated in over half of “unexplained” third-trimester stillbirth.”

3. Ultrasound Diagnosis and Management of Umbilical Cord Abnormalities, Junichi Hasegawa, Ryu Matsuoka, Kiyotake Ichizuka, Akihiko Sekizawa, Takashi Okai Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan. Taiwan J Obstetrical Gynecology, March 2009, Vol 48, No 1

Summary: “The incidence of placenta and umbilical cord abnormalities is high in abnormal course of the delivery. Although the detection rate of umbilical cord abnormalities is steadily increasing with the improvement of

ultrasound technology, and the fact that ultrasound scanning can distinguish umbilical cord conditions, this information has not exerted much impact on the management of labor to date. Prenatal detection of umbilical cord abnormalities can reduce the number of emergency cesarean sections and intrauterine fetal deaths. In this review, the authors describe the ultrasound diagnosis and management of major umbilical cord abnormalities, including abnormalities of cord insertion site (velamentous and marginal cord insertion), hypercoiled cord and nuchal cord, considering the current knowledge on physiologic and pathologic aspects of each umbilical cord abnormality.”

4. Placental position and late stillbirth: a case-control study, Jane Warland, McCutcheon, and Baghurst, Journal of Clnical Nursing, 18, 1602-1606, 2009.

Results: “Women who had a posterior located placenta were statistically more likely to suffer a stillbirth than women who had a placenta in any other position. Posterior located placenta may be a contributory risk factor

for stillbirth. Further research warranted. Implications for Practice: Nurses and midwives should be aware of this potential risk factor to monitor foetal well-being closely.”

5. Does low blood pressure increase the risk of stillbirth? Erick Hodgson, MD and E. Norwitz, MD, PhD.,Chief Resident, Yale University School of Medicine, Contemporary Ob/Gyn, October 2006.

Key point: “Despite conventional wisdom, low blood pressure (hypotension defined as a maximum diastolic blood pressure of less than 65 mm Hg) in the third trimester may not be reassuring observation. Indeed, recent

studies suggest that it may be a risk factor for stillbirth. However, these data should be regarded as preliminary…”

6. Maternal Blood Pressure in Pregnancy and Stillbirth: A Case-Control Study of Third Trimester Stillbirth, Jane Warland, McCutcheon, and Baghurst, American Journal of Perinatology, 25(5) 311”317,April 200.8

Conclusion: “This study’s findings, along with the work of Steer et al, lends some credence to the findings of the earlier German studies, that maternal hypotension in pregnancy increases the risk of stillbirth, particularly

borderline hypotension. Furthermore, it appears that results from our research support active management of hypertensive disease in pregnancy  and that such management is reducing the risk of stillbirth in this group.”