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Stillbirth Research and Education Submission

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Stillbirth Research and Education Submission To the Committee on Stillbirth Inquiry: Umbilical Cord Pathology is a significant cause of stillbirth . Stillbirth Prevention requires addressing UCA which can be imaged and managed. Dear Senator Keneally, Your initiation of "Inquiry into stillbirth in Austrailia" caught my attention. Buzz Feed's story of Ms Imrie and yours are not uncommon. Stillbirth can be prevented and It would be a privileged to assist you in your endeavor. We observed that stillbirth occurs during maternal sleep .This has been published and later confirmed by several studies including one from NZ. The observation means stillbirth is at a definate time and not random. This means it can be prevented. We have used Home Fetal Monitoring for 25 years to address this tendancy. Please let me know if you would like to discuss this approach. Regards, Jason H Collins MD,MSCR 1566 Letters December 1997 .aan .] Obstet Gynecol lation of a radiopaque contrast medium (Thorotrast) accidents. Over a 1-year period >2000 "hits" have been after intraamniotic injection. Because delivery is likely recorded. These inquiries led to 20 consecutive inter- to occur in a short period of time, the degree of views from around the United States. Questions per- therapy that could be provided may be limited. Finally, tained to the events surrounding stillbirth caused by an intraamniotic fetal lung therapy may be more effective umbilical cord accident. Mothers seemed to readily if the therapeutic agent is delivered before the onset of remember the details of fetal behavior and all recalled labor at a time when the fetus breaths more actively fetal movement the day before death. Table I summa- and when the fetus can be exposed to the agent for an rizes these cases and surprisingly suggests that the major- extended period of time. i V of deaths were during the mother's sleep cycle (12 Henry L. Galan, MD midnight to 7 a~). Fetal death could be explained by Department of Obstetrics and Gynecology, University of Colorado Health known physiologic changes which occur during maternal Sciences Center, 4200 E. 9th Ave., Campus Box B-198, Denver, CO sleep, t' 2 Stressed fetuses with intermittent cord compres- 8O262 sion may be more susceptible to physiologic changes than are unstressed fetuses during maternal sleep. Ani- REFERENCES mal models suggest that labor is designed for nighttime 1. Ahfeld F. Die intrauterine Tfitigkeit der thorax- und zwerch- birth. Could humans have nighttime (sleep cycle) tern fellmuskulatur: intrauterine atmung. Monatsschr Geburt- dencies that are detrimental to the stressed fetus? A more shilfe Gynakol 1905;21:143-63. 2. Boylan P, Lewis PJ. Fetal breathing in labor. Obstet Gynecol extensive and structured interview process with mothers 1980;56:35-8. of stillbirths may be important, especially in determining 3. Davis ME, Potter EL. Intrauterine respiration of the human patterns of fetal behavior and the time of death. In the fetus. JAMA 1946;131:1194-2101. situation of umbilical cord accidents knowing that the 6/8/86499 time of death could be a predictable pattern may be clinically useful. Jason H. Collins, MI) Pregnancy institute, 2250 Gause Blvd., Suite 200, Slidell, LA 70461 Umbilical cord accidents--Time of death? To the Editors: Umbilical cord accidents appear to be random events relative to gestational age, time, and REFERENCES labor. Stillbirths occurring before labor seem mysterious 1. Siamopoulos KC, et al. Ambulato~" blood pressure monitor- and unpredictable. Could the events leading up to ing in normotensive pregnant women. J Hum Hypertens stillbirth be detectable and observable such as with a 1996;10(suppl 3):551-4. 2. Hoppenbrouwers, et al. Fetal heart rate during maternal prolapsed umbilical cord after rupture of membranes? sleep. Obstet Gynecol 1981;57:301-9. The Pregnancy Institute maintains a web site (www. preginst.com) that addresses the issue of umbilical cord 6/8/86502 Table I. Umbilical cord accident--Time of death Patient Gestational Fetal movement, Fetal movement, No. age (wk) 71'1vi-12 midnight after 7 a,u Cord accident 1 38 + NC× 2 2 36 + NC × 2/TN 3 36 + TN 4 39 + NC×2 5 38 + NC×2 6 39 + TN× 2 7 39 + NC × 1/TN 8 38 + NC× 2 9 37 + Torsion 10 38 + NC× 1 11 32 + NC × 1/BL × 2 12 36 + AL × 1/183 cm 13 38 + TN 14 36 + NC× 1 15 40 + NC x 2/~U X 1 t6 39 + BL?/Meconium 17 39 + NC × 3/TN 18 32 + NCx3 19 40 + TN 20 32 + Torsion NC, Nuchal cord; TN, true knot; BL, body loop; AL, ankle loop. To the Committee on Stillbirth Research and Education Stillbirth Attention Committee Secretariat Stillbirth is a world wide issue which claims several million babies a year. Although the medical definition of stillbirth varies from location to country the impact is the same to the families and community. This submission addresses Terms of Reference H - related matters. Stillbirth is preventable , it is not a mystery . Regardless of the cause , stillbirth is a mammalian event based on Circadian rhythms. The main element of this causation is Melatonin the hormone which regulates our 24hr clock. Pregnancy Institute (PI) is a non-profit 501C-3 research project focused on a cause of stillbirth Umbilical Cord Accidents (UCA). 15%-20% of worldwide stillbirth is caused by UCA. PI first reported the association between maternal sleep and stillbirth and continues to study the event. UCA is a definable cause of stillbirth which can be imaged , managed , and a successful birth accomplished. Any endeavor to address stillbirth ,which includes accurate data bases (none exist), International research (UCA is universal in all ethnic groups),proper levels of funding, obstetrical education (there are no educational forums on UCA),patient awareness literature and economic impact of UCA is needed. There is innovative new tech that can address stillbirth. PI has worked with several vendors over 25 years to perfect Home Fetal Heart Rate Monitoring. Home Fetal Heart Rate Monitoring can be done by the mom anywhere there is a cell tower/internet connection.Moms can self monitor with ease and effectively participate in their babies well being. Attached are several items to support the above statements. Please let me know if you would like additional evidence to the above. There is much published research about all this if interested. Stillbirth is preventable once it is understood. Regardless of the cause - stillbirth is a maternal sleep event. Regards, Jason H Collins MD,MSCR Clinical significance of melatonin receptors in the human myometrium James Olcese, Ph.D. and Stephen Beesley Ph.D. Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida Objective: To review and update the research on melatonin receptor expression in the human myometrium, in particular as it pertains to uterine contractility at labor. Design: Summary of previous studies with the addition of new data on the transcriptional regulation of melatonin receptor expression in human myometrial cells. Setting: Not applicable. Patient(s): Late-term pregnant volunteers. Intervention(s): Biopsy collection for in vitro analyses provided the original data. More recently, uterine contractions in late-term pregnant volunteers were assessed before, during, and after acute white-light exposure. Main Outcome Measure(s): Melatonin receptor signaling in myometrial cells and uterine contractions in late-term pregnant volunteers. Result(s): Melatonin acts through the MTNR1B melatonin receptor that is expressed in the myometrium at late term to synergistically enhance oxytocin-dependent signaling and contractions. Acute inhibition of endogenous melatonin levels with light reversibly suppresses uterine contractions. Conclusion(s): These results point to a significant role for circulating melatonin in the timing and degree of uterine contractions in late-term pregnancy. Understanding the regulation of melatonin receptors remains a future objective. (Fertil SterilÒ 2014;102:329–35. Ó2014 by Use your smartphone American Society for Reproductive Medicine.) to scan this QR code Key Words: Myometrium, melatonin, receptors, contractions, light and connect to the discussion forum for Discuss: You can discuss this article with its authors and with other ASRM members at http:// this article now.* fertstertforum.com/olcesej-melatonin-receptors-human-myometrium/ * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. he events leading up to parturi- phorylated myosin light chain kinase, reported by several groups to occur T tion in the human are complex etc.), changes in the expression of mem- most frequently during the late night and still poorly understood. brane ion channels, and enhanced and early morning hours, i.e. between Clearly, interactions between hormon- intercellular connectivity due to strong 10:00 PM and 8:00 AM (2–5). In late al, mechanical, and other signals are expression of the gap junction protein pregnancy, uterine contractions are key in reversing the quiescent uterine connexin 43 (1). The precise timing of more frequent during the nighttime state, which is present throughout labor onset in the human largely de- hours in both human and nonhuman most of pregnancy, into a strongly pends on the duration and strength of primates (6, 7). These physiological active contractile state capable of these events, as well as the position events are not random, and indeed expelling the fetus and placenta. and number of fetuses, maternal pelvic they reflect processes that intersect Among the physiological events that dimensions, and many other factors. with the cellular basis for labor onset. appear to significantly underlie the A feature of human parturition that In this context, we describe here our lengthy process of uterine activation is often neglected is its strong associa- findings of an additional contributor and ultimately labor onset are increased tion with the rest phase of the 24-hour to the nocturnal timing of uterine expression of contractile-associated sleep–wake cycle.
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