Umbilical cord accident 2

24 Aug

I realized that the umbilical cord page was missing the latter portion of the original book chapter. The wording was not identical with the page already on the web, but the section divides were identical. I copied that second portion to the new page. I can not upload videos with this free version of WordPress.

Just added page on fetal vascular malperfusion

23 Aug

I added a page from the obstetrical pathology textbook I had intended to publish. My goal was to create a book for both obstetricians, and pathology residents/fellows. Many of the pages I have published on this site are from that effort. I have tried to update some, but they would all need further updating and editing; nevertheless I hope they will be useful.

The pages also reflect the basis for the detailed anatomic portion of the protocol for the Stillbirth Project. Even if I never find a position from which I can accomplish that study, the pages will be a source of references and explanations should someone else want to carry it through.

Pathology Manual

19 Aug

I am going to post the material from my lectures on stillborn autopsy technique. The images are not meant for the general public, and I have labeled them Pathology Manual. They lay the foundation for the fuller development of the stillbirth research protocol, and may be useful to residents and fellows in pathology. I could not recover the original images and used the powerpoint images that are of lower resolution than I would have preferred. The plan is replace these over time with better images. I will be posting each topic separately and have already posted Postmortem Retention, and now Gestational Age.

The goal of the Stillbirth Study is to have the best clinical estimate of gestational age, and to compare it with the gestational development external and internal anatomic features of the infant. Gestational age is a foundation for evaluating the cause of death. The study would also investigate any independence of individual organ system development from the overall development.

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, bendonrw@gmail.com.  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.

Open letter to obstetricians

18 Jul

Some of the pages on this blog were from a sequential series of historical chapters on fetal asphyxia starting from Dr. Little and progressing to Dr. Ron Myers key discoveries in free range monkeys, and then to later refinements in ovine models. The final chapter was on the medico-legal implications.

I have summarized this effort in the open letter that I just posted. The scientific basis of this letter is in the other posted pages on the site which review the published literature with references. I would be grateful to pathologists who utilized this site, if they would give this letter to obstetrician colleagues, and hopefully provide me with some feedback.

My email address is bendonrw@gmail.com.

Thanks,

 

Bob Bendon, MD

Postmortem retention etc.

11 Jul

My older blog had my power point lectures on the perinatal autopsy. When I gave those lectures, I had a detailed handout for each slide. I had intended to publish these as an appendix to the book that will never be published. I had not planned to blog these lectures again. However, I had promised a local pathologist who had lent me the use of a microscope to send him the references to the articles by Genest and colleagues that I had found very useful. To accomplish that goal,  I have posted a page on this topic. I hope it is useful to others as well.

Breus Mole etc.

30 May

I have added another page on subchorionic lesions on the placental surface. This was a segment of a chapter I wrote (unpublished) that followed the section on retroplacental hematoma. The previous page on placenta accreta precedes that section. A condensed versions of the RPH section will I hope soon be published in “Pathology of the Placenta: A Practical Guide” editors Khong, Mooney, Nikkels, Morgan and Gordijn.