Click here for Stillbirth Summit 2011 Summary as published in the BMC Journal
Organized and funded by Star Legacy Foundation
Minneapolis, Minnesota: 6-8 October 2011
Between the 6th the 8th of October, a varied collection of researchers, stillbirth advocates and parents gathered together in sunny Minneapolis to discuss novel ideas relating to stillbirth risk and management. The main objectives of the forum were to discuss emerging ideas in the field of stillbirth research and to identify resources and opportunities for supporting stillbirth families.
Format of the meeting
The unique format of the meeting was the “roundtable” of researchers, with a large group of women and families who had been affected by stillbirth and a number of parental organizations present. A much larger amount of time was allowed for open discussion which enabled issues to be explored in greater depth than usually occurs at traditional “scientific” meetings. There was invaluable input from parents, who ensured that the meeting had energy and focus.
The placenta and the cord
A number of presentations discussed the importance of placental pathology. The placenta is the lungs and stomach for the baby while in utero – in some cultures the placenta is considered to be an integral part of the baby and is buried in a place of significance. A number of researchers behove us to pay attention to the placenta and to look to it to provide clues not only to the death of a baby but as a way of predicting poor outcome.
Dr Harvey Kliman persuasively argued the importance of the relationship between placental size and pathology and risk of stillbirth. Specifically, he suggests that placental volume may predict birth weight and by association, outcome of pregnancy. Dr Kliman has developed a simple method for estimating placental volume in utero (that can even be downloaded as an iphone app) and recommended that placental volume be calculated at each ultrasound scan.
The placenta: potential early warning system
Dr. Alex Heazell’s talk followed on well from Dr Kliman’s and suggested that through the use of bio markers of placental function in early pregnancy, the placenta may help to predict babies of greater risk of stillbirth. Dr Heazell also argued for the importance of placental histology and placental research in order to develop a greater understanding of the cause of stillbirth.
Placental pathology and the cord
Another advocate of the importance of the placenta and the cord was Dr Mana Parast who hypothesised that non-acute cord accidents can lead to loss of placental function through the involution of vessels in the terminal chorionic villi. Dr Parast has published a number of papers that have described the association between cord abnormalities and related placental histology. She also commented on the low number of clinicians trained in placental pathology.
Cord around the neck syndrome
Dr Morarji Peesay reminded us of the frequency of nuchal cords – in more than 25% of pregnancies. Dr Peesay put forward the argument that nuchal cords are not only associated with fetal death but also other long term poor outcomes (such as cerebral palsy).
Cord torsion and entanglement
Dr Jason Collins, a passionate and dedicated believer in the role of cord issues in the outcome of pregnancy, spoke of the lack of attention paid to cord issues amongst researchers and clinicians. Dr Collins suggested that there should be routine antenatal surveillance of the cord (including cord torsion and cord entanglement) and that antenatal management should be responsive to these findings. Specifically, he suggested that this management should include home monitoring of the fetal heart rate. Dr Collins’ talk generated considerable debate about the importance of conducting robust research that can be peer reviewed and disseminated in order to convince other clinicians of the potential benefit of his approach to the management of cord issues in pregnancy.
Dr Uma Reddy discussed the complex findings regarding the role of thrombosis in stillbirth risk. There still appears to be little consensus as to the significance of thrombophilia in perinatal outcome. The discussion also considered the differences between homozygous and heterozygous clotting issues and their treatment. Dr Reddy’s presentation highlighted the importance of study design in the interpretation of findings relating to risk.
Infection and inflammation
Dr James McGregor reminded us how little we still know of the impact of infection and inflammation on fetal wellbeing. However, there are well known examples that treatment of infection prevents stillbirth. Examples include syphilis, Group B Strep, malaria. He also commented on the role of invasive procedures in the spread of infection.
Low blood pressure
Dr Jane Warland presented findings from her research on maternal blood pressure in pregnancy and the association between low blood pressure and increased risk of stillbirth- an under explored association. It was felt that this was an area of interest and that definitions of maternal hypotension need to be developed and that there should be further exploration in this area.
Reduced fetal movements
The role of maternal perception of fetal activity was discussed at various times during the summit. Dr Alex Heazell presented evidence of the association between reduced fetal movements and fetal compromise and presented findings from his study on placental changes in women who have presented with reduced fetal movements. Dr Heazell argued that increasing maternal awareness of fetal activity may be a way of reducing stillbirths. General discussion also took place on the