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Umbilical cord accidents—Time of death: Continued

1998; Elsevier BV; Volume: 179; Issue: 1 Linguagem: Inglês

10.1016/s0002-9378(98)70295-9

1097-6868

Jason H. Collins,

Birth, Development, and Health

To the Editors:We are interested in the article by Lunshof et al (Lunshof S, Boer K, Wolf H, van Hoffen G, Bayram N, Mirmiran M. Fetal and maternal diurnal rhythms during the third trimester of normal pregnancy: Outcomes of computerized analysis of continuous twenty-four–hour fetal heart rate recordings. Am J Obstet Gynecol 1998;178:247-54) because of the coincident nature of their data with our study of time of death in umbilical cord accidents. A recent letter by us suggested that stillbirths associated with cord entanglement were occurring during maternal sleep. Our original case number has gone from 20 to >40 cases interviewed. In a continuing investigation of this pattern we have encountered recent literature that suggests that there may be a common association of sleep patterns and vascular accidents. Occlusive stroke cases and occlusive coronary cases seem to be prevalent during sleep. The common denominator may be blood pressure declines during deep sleep.1Qureshi AI Giles WH Croft JB Bliwise DL Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I.Neurology. 1997; 48: 904-911Crossref PubMed Google Scholar, 2Wroe SJ Sandercock P Bamford J Dennis M Slattery J Warlow C Diurnal variation in incidence of stroke: Oxfordshire community stroke project.BMJ. 1992; 304: 155-157Crossref PubMed Scopus (145) Google Scholar, 3Neutel JM Smith DH The circadian pattern of blood pressure: cardiovascular risk and therapeutic opportunities.Curr Opin Nephrol Hypertens. 1997; 6: 250-256Crossref PubMed Scopus (39) Google Scholar When this was investigated further, several cases were found that documented fetal heart rate decelerations during maternal sleep as part of the Perinatal Umbilical Cord Project. An example is provided of a case with a 38-week fetus with a prenatally diagnosed double nuchal cord.The possibility exists that circadian rhythms may account for physiologic changes that are detrimental to the stressed fetus. If the same principles affect other compromised vascular states and can lead to stroke and coronary occlusion during sleep, the same influences may be at work with umbilical cord entanglement. To the Editors:We are interested in the article by Lunshof et al (Lunshof S, Boer K, Wolf H, van Hoffen G, Bayram N, Mirmiran M. Fetal and maternal diurnal rhythms during the third trimester of normal pregnancy: Outcomes of computerized analysis of continuous twenty-four–hour fetal heart rate recordings. Am J Obstet Gynecol 1998;178:247-54) because of the coincident nature of their data with our study of time of death in umbilical cord accidents. A recent letter by us suggested that stillbirths associated with cord entanglement were occurring during maternal sleep. Our original case number has gone from 20 to >40 cases interviewed. In a continuing investigation of this pattern we have encountered recent literature that suggests that there may be a common association of sleep patterns and vascular accidents. Occlusive stroke cases and occlusive coronary cases seem to be prevalent during sleep. The common denominator may be blood pressure declines during deep sleep.1Qureshi AI Giles WH Croft JB Bliwise DL Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I.Neurology. 1997; 48: 904-911Crossref PubMed Google Scholar, 2Wroe SJ Sandercock P Bamford J Dennis M Slattery J Warlow C Diurnal variation in incidence of stroke: Oxfordshire community stroke project.BMJ. 1992; 304: 155-157Crossref PubMed Scopus (145) Google Scholar, 3Neutel JM Smith DH The circadian pattern of blood pressure: cardiovascular risk and therapeutic opportunities.Curr Opin Nephrol Hypertens. 1997; 6: 250-256Crossref PubMed Scopus (39) Google Scholar When this was investigated further, several cases were found that documented fetal heart rate decelerations during maternal sleep as part of the Perinatal Umbilical Cord Project. An example is provided of a case with a 38-week fetus with a prenatally diagnosed double nuchal cord.The possibility exists that circadian rhythms may account for physiologic changes that are detrimental to the stressed fetus. If the same principles affect other compromised vascular states and can lead to stroke and coronary occlusion during sleep, the same influences may be at work with umbilical cord entanglement. We are interested in the article by Lunshof et al (Lunshof S, Boer K, Wolf H, van Hoffen G, Bayram N, Mirmiran M. Fetal and maternal diurnal rhythms during the third trimester of normal pregnancy: Outcomes of computerized analysis of continuous twenty-four–hour fetal heart rate recordings. Am J Obstet Gynecol 1998;178:247-54) because of the coincident nature of their data with our study of time of death in umbilical cord accidents. A recent letter by us suggested that stillbirths associated with cord entanglement were occurring during maternal sleep. Our original case number has gone from 20 to >40 cases interviewed. In a continuing investigation of this pattern we have encountered recent literature that suggests that there may be a common association of sleep patterns and vascular accidents. Occlusive stroke cases and occlusive coronary cases seem to be prevalent during sleep. The common denominator may be blood pressure declines during deep sleep.1Qureshi AI Giles WH Croft JB Bliwise DL Habitual sleep patterns and risk for stroke and coronary heart disease: a 10-year follow-up from NHANES I.Neurology. 1997; 48: 904-911Crossref PubMed Google Scholar, 2Wroe SJ Sandercock P Bamford J Dennis M Slattery J Warlow C Diurnal variation in incidence of stroke: Oxfordshire community stroke project.BMJ. 1992; 304: 155-157Crossref PubMed Scopus (145) Google Scholar, 3Neutel JM Smith DH The circadian pattern of blood pressure: cardiovascular risk and therapeutic opportunities.Curr Opin Nephrol Hypertens. 1997; 6: 250-256Crossref PubMed Scopus (39) Google Scholar When this was investigated further, several cases were found that documented fetal heart rate decelerations during maternal sleep as part of the Perinatal Umbilical Cord Project. An example is provided of a case with a 38-week fetus with a prenatally diagnosed double nuchal cord. The possibility exists that circadian rhythms may account for physiologic changes that are detrimental to the stressed fetus. If the same principles affect other compromised vascular states and can lead to stroke and coronary occlusion during sleep, the same influences may be at work with umbilical cord entanglement.