A Simple Measure: Kick counts (and a plea for measuring the untethered length of the umbilical cord)

8 Sep

The following news article on Kick Counts strikes me as very important:

 https://www.huffingtonpost.com/entry/counting-kicks-prevent-stillbirths_us_5b927693e4b013f66bd56b19

The success of a program to educate mothers about kick counts in reducing stillbirth may still need further confirmation in other states, but it is a very promising start.

The obstetricians seem to accept the cord wrapping as the cause of death. No one is still doing another simple measure, the length of cord from the start of the wrapping to the placenta. Our simple in vitro research suggests that too short of a functional free cord length put the cord for risk of torsion that can collapse umbilical vein blood flow. If obstetricians started recording this length we might learn when the shortness of this distance becomes dangerous.

The article also does not state explicitly, but implicitly shows, that there is time to rescue the infant. The innovative studies of Drs Theonia Boyd, Mana Parast and others have shown that there is time for fetal vascular occlusive lesions to develop in the placenta, which is evidence of hours to days of a continuing or intermittent process, before fetal death. The autopsy of stillborn infants often shows pleural and pericardial effusions, and dilated cardiac chambers, suggestive of less than immediate asphyxia. The pathology evidence suggests that some stillbirths can be detected and prevented. This innovative inexpensive program to just educate mothers is perhaps the most encouraging evidence yet. When I was on the FIMR panel in Louisville, mothers were often aware of some decreased fetal movement, but did not know that this was potentially (certainly not always) a symptom of fetal hypoxia and needed prompt evaluation.

Note: I have not reviewed clinical studies of kick count as an intervention. I have one reference showing a lack of effectiveness. (1) There is an area that I would not ordinarily review as a pathologist. Does anyone have a useful review?

(1) Grant A, Elbourne D, Valentin L, Alexander S: Routine formal fetal movement

counting and risks of antepartum late deaths in nomally formed

singletons. Lancet 1989, 2:345-347.

 

 

 

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