Silent Risk

With 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. The American Association of Ultrasound Technologists has defined these parameters for umbilical cord B.1.4; Abnormal insertion B.1.5; Vasa previa B.1.6; Abnormal composition B.1.7; Cysts, hematomas, and masses B.1.8; Umbilical cord thrombosis B.1.9; Coiling, collapse, knotting, and prolapse B.1.10; Umbilical cord evaluation with sonography includes the appearance, composition, location, and size of the cord Cord Although many stillbirths are attributed to a cord accident, this diagnosis should be made with caution. Cord abnormalities, including a Nuchal Cord, are found in approximately 30% of normal births and may be an incidental