Stillbirth Research Idea

16 Aug

I have posted the outline/synopsis of a research idea for studying the underlying causes of stillbirth as part of an intense postmortem analysis. As I have argued on this site, I believe intrauterine asphyxia is an important cause of stillbirth even in cases where a specific cause of such asphyxia had not been discovered. I think some hidden causes may be revealed if we could image the umbilical cord in utero prior to delivery of the infant. I have argued how cord wrapping can produce a functionally short cord and in one of my own daughters I have seen the effect of occult cord prolapse. The key advance that makes this study novel is the ability of MRI to identify the anatomic position of the cord in utero. I hope that a study of stillbirth will allow early identification of potentially dangerous cord entanglements and positions that could lead to novel therapies of prevention. I also hope that such information will aid in a better understanding of intrauterine asphyxia in labor and prevent complications and prevent Cesarean sections by again novel approaches to the problem.

Of course the etiologies of stillbirth are more complex and may be a confluence of factors that decrease fetal oxygenation or acid/base balance such as maternal sleep position or sleep apnea, maternal ketosis, various causes of compromised utero-placental circulation, uterine contractors, and unknown factors. This proposal suggests even more detailed postmortem history of the parents, a kind of review of systems, and narrative of events. I also propose detailed analysis of each case with some novel approached to the autopsy and placental examination to be discussed. There are also new blood markers that may be able to aid in identifying conditions such as sleep apnea after the fact. Finally, I propose the review of each case after  the postmortem evaluation is deemed complete by a team with the aim of continuing modification of the study methodology.

This study is an extension of the postmortem examination. Numerous risk factors have been identified for stillbirth, but as an example, obesity is a risk factors, but the direct mechanism of death in an individual infant involves more than just maternal obesity. The goal in each case is to improve our ability to explain the death of the infant to the parents and to ourselves. By looking at each case in detail, not for risk factors, but for a plausible and, as much as possible, provable, sequence of biological mechanisms. The constant review of the cases will accumulate knowledge that cannot be obtained otherwise, and hopefully will set the stage for controlled trials of new approaches. Stay tuned.

If anyone is interested in joining the study please email me,  I have a Powerpoint that explains some more detail. The study is still at an early point in development, and is not funded. However, commitments to the concept by obstetricians, pathologists, radiologists, and nurses will help provide concrete evidence to potential funders that the project is viable.

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