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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 2008
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.”
7. Management of Stillbirth, ACOG Practice Bulletin, Number 102, March 2009.
The Purpose of this bulletin is to review current information on stillbirth, including definitions and management, the evaluation of a stillbirth, and strategies for prevention.
11. Gross Abnormalities of the Umbilical Cord: Related Placental Histology and Clinical Significance
19. The association between stillbirth in the first pregnancy and subsequent adverse perinatal outcomes.
The National Institute for Clinical Excellence guidelines on routine antenatal care for the healthy pregnant woman acknowledge that low-risk mothers almost invariably give birth in a straightforward manner to low-risk babies. They do not, however, address the difficulties of identifying the high-risk fetus in the low-risk mother. Of the 4000 annual ‘unexplained’ stillbirths in the UK, 1000 are below the tenth centile for birthweight. We believe that ultrasound assessment of fetal wellbeing and growth should be part of the routine examination of the fetus.
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