Jason H Collins MD,MSCR

OB Facts: More evidence of umbilical cord pathology causing poor outcomes . There needs to be a discussion in OB professional organizations about the need to document umbilical cord imaging findings and a management of the risks involved.

OB Facts : Iran stillbirth study reporting a high incidence of umbilical cord pathology as cause of death. This finding is being reported worldwide. It is time for discussion about prenatal imaging of UCA issues.

Fetal behavior is consistent. Starting at @28 weeks babies will move at bedtime when mom reclines. It is a fetal reflex . Too little response , go to Labor and delivery. Too much response (hyperactivity) go to Labor and delivery. No permission needed to go. A full evaluation is required .

The best monitoring tool we have? You. You know your baby’s patterns better than anyone else. Trust your instincts. If something feels off, say something — and keep saying it until you’re heard. Read more tips: hubs.li/Q03Wg_gx0

OB Facts : Fetal behavior is an indication of fetal wellbeing. Fetal kicks is one of several behaviors . When a mom lays down she triggers fetal reflexes . This is well illustrated by a news cartoon.By @ 26 weeks babies establish a behavior pattern that can be tracked at bedtime . Learn your babies pattern at bedtime. Changes should prompt a visit to Labor and Delivery.

OB Facts : Multiple reports on Umbilical Cord Pathology and poor outcomes. A recent stillbirth conference had no lectures on UCA. Any baby born alive or stillborn with umbilical cord findings needs a placental review. The placental lesion “fetal vascular malperfusion” is diagnostic of umbilical blood flow disruption.

OB Facts : Self driving cars are being tested in some cities .This advancement can potentially impact prenatal care access . Hand held ultrasound will mobilize fetal assessment to the underserved patient .Tests as simple as amniotic fluid index will be possible at home .

OB Facts : It is time to start a dialog about Autonomous Prenatal Care. Innovation can evolve quickly. The Wright brothers flew in 1903. The 747 flew in 1969. Home monitoring products such as Blood pressure cuffs and urine test strips can combine with developments in autonomous vehicles to bring humanoid care givers to outlying communities where data can be gathered and reported . AI will identify pregnancies at risk to bring to an OB care center for more detailed evaluation .

OB Facts: More evidence for umbilical cord review starting with the 20wk anatomy scan. This review article points to over 1800 articles on VP . How much evidence is needed before this pathology is included as a required detail of an ultrasound review of pregnancy .

OB Facts : Velamentous Umbilical Cord Placental insertion is a risk factor for poor outcomes . The 20wk ultrasound needs to photograph and document the umbilical cord insertion . The mom needs to be informed of the finding. Due to FDIU ( fetal death in utero).

OB Facts : Umbilical Cord Length is a detail that should be documented at the 20 wk anatomy scan . A short cord <30cm and a long cord >70cm are known risk factors for poor outcomes. This fact has been published since the 1950s. It is time to document this U/S finding .

OB Facts: Home Fetal Heart Rate monitoring began with NASA at an Indian reservation. Today internet/Wifi based home monitoring is doable and feasible. This innovation can be done by moms with concerns about their pregnancies.

@EM_RESUS Paprycus fetus

OB Facts : Prenatal diagnosis of umbilical vein cyst . Successfully managed with early delivery. Placental pathology showing Fetal Vascular Malperfusion with chorangiosis and nucleated red blood cells.

OB Facts: More evidence that umbilical cord characteristics need to be documented at the 20wk exam. Abnormal measurements need repeat ultrasound exams .

OB Facts: Prenatal diagnosis of an umbilical cord cyst with management and good outcome.Umbilical Cord Pathology can be imaged prenatally and managed to avoid stillbirth.

OB Facts : Umbilical Cord True knot can be imaged and Managed. Many case reports now demonstrate this ability of modern ultrasound to visualize true knots. These cases must be followed weekly with ultrasound to look for additional entanglement. It is no longer acceptable to loose a term baby to a true knot.

OB Facts : It is no longer acceptable to ignore a true knot imaged on ultrasound . These cases need frequent monitoring and imaging for complex UCA.MRI should be considered for better detail.

OB Facts: More evidence regarding documenting the umbilical cord insertion into the placenta at the 18/20wk anatomy scan . This should be done with color doppler imaging.It is especially important in IVF patients.

OB Facts : Placental location and umbilical cord insertion should be documented at the 20 wk anatomy scan. Pathologic findings need to be addressed by frequent fetal evaluations.Home fetal monitoring should be considered where needed.