Silent Risk: Issues about the Human Umbilical Cord, 2nd Edition

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9781499039108: Silent Risk: Issues about the Human Umbilical Cord, 2nd Edition
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W ith an estimated 8 000 deaths per year in the United States from complications of UCA an initial goal of 50 reduction of loss is possible To achieve this goal requires the recognition by the obstetrical community of the issue Recent research into circadian rhythms may help explain why UCA stillbirth is an event between 2 00 a m and 4 00 a m Melatonin has been described as stimulating uterine contractions through the M2 receptor Melatonin secretion from the pineal gland begins around 10 00 p m and peaks to 60 pg at 3 00 a m Serum levels decline to below 10 pg by 6 00 a m Uterine stimulation intensifies during maternal sleep which can be overwhelming to a compromised fetus especially one experiencing intermittent umbilical cord compression due to UCA It is now time for the focus to be on screening for UCA managing UCA prenatally and delivery of the baby in distress defined by the American College of Obstetricians and Gynecologists as a heart rate of 90 beats per minute for 1 minute on a recorded nonstress test the ability of ultrasound and magnetic resonance imaging MRI to visualize UCA is well documented the 18 20 week ultrasound review should include the umbilical cord its characteristics and description of its placental and fetal attachment Bettye Wilson MEd R T R CT RDMS FASRT Fellow of the American Society of Radiologic Technologist recommended in RADIOLOGIC TECHNOLOGY March April 2008 Vol 79 No 4 pg 333S 345S That an umbilical cord evaluation with sonography should include the appearance composition location and size and length of the cord In addition Abnormal Insertion in the placenta and fetus Vasa Previa Abnormal composition single umbilical artery Cysts Masses Hematoma Umbilical Cord Thrombosis Coiling helices collapse knotting and prolapsed funic presentation Cord Events Although many stillbirths are attributed to a cord accident this diagnosis should be made with caution Cord abnormalities including

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