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Case Study 3 - Umbilical Cord Accidents - Time of Death 
Jason H. Collins, M.D.


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Pregnancy Institute has operated a Web site since July 1996. Over 5500hits have been recorded since its start up. One of the topics discussed is Umbilical Cord Accidents. E-Mail from parents experienced with this form of stillbirth began to share their case stories with Pregnancy Institute. These inquiries led to a series of interviews now numbering 60 stillbirths. (table 1) Most of the pregnancies were term and around from the U.S. Some were from outside of the U.S. Questions pertaining to the events that preceded the stillbirths focused on fetal behavior and time of fetal movement prior to death. Mothers and fathers seemed to readily remember these details and all recalled fetal movement the day before demise. Surprisingly all deaths were associated with the mothers sleep cycle. Most deaths occurred between 12 midnight and 7 am. Some anecdotal events timed the deaths at between 3am - 7am. Two deaths were timed at 3pm - 5pm during afternoon naps described as deep restful sleep. (fig1)

Is it possible that these deaths were not random but the result of physiological changes which occur during maternal sleep? Could cord entangled fetuses be stressed to the degree where these changes are detrimental whereas unstressed fetuses can adapt. Fetal and Maternal biorhythms suggest that there are changes during maternal sleep. 1 2 3 Also there are similar mechanisms which explain occlusive stroke and occlusive coronary disease. All these events seem to be prevalent during sleep and especially in the early morning. 456

Investigating this further, several cases have been observed as part of the Perinatal Umbilical Cord Project. An example is provided of a case with a 38 week fetus with a prenatally diagnosed double nuchal cord. (figure 1) During maternal sleep (R side) B/P readings q 30 min showed a decline from 120/70 (awake) to 98/53 at 3:40 am. At this time a contracture (3-4 min) is associated with a late deceleration. An OCT the next morning resulted in a C/Section for an abnormal fetal heart rate pattern. Additional observations as shown in Figures 2-4.

The possibility exists that circadian rhythms may be detrimental to the stressed fetus. In particular, maternal sleep may be associated with maternal hypo tension and fetal hypoxia. As with compromised vascular states which can lead to stroke and coronary occlusion during sleep, the same principles may be affecting the cord entangled fetus.

TABLE 1

FIGURE 1

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