Fetal Death Secondary to Constriction and Torsion of Umbilical Cord: An autopsy case

Kim, Yeon Mee; Chi, Je G

Abstract

Localized constriction and torsion of the umbilical cord are rare cord abnormalities. The seg- mental absence of Whartion's jelly in the involved area of the cord is believed to be an etiologic factor of the constriction and subsequent torsion. In the past, constriction and torsion were thought to occur after the death of the fetus as a result of maceration. However, recently it has been suggested that the torsion of the constricted area might cause fetal death. We report an autopsy case of a localized constriction and torsion of the umbilical cord in a stillborn baby. The baby was delivered to a 27-year-old primiparous woman after 28 weeks gestation. The fetus was of 24 gestational weeks in size and weight. And the placenta weight was 259 gm. A grossly macerated fetus showed a cystic hygroma in the posterior neck. There were two areas of constriction in the umbilical cord, one at the squamoamniotic junction and the other, 15 cm from the fetal end. Torsions were noted in both constricted areas, more severe than in the mid portion of the cord. Microscopically, the Whartion's jelly was deficient and partly replaced by fibrosis in the constricted areas. It is believed that these two areas of constrictions and torsion are causally related to the intrauterine fetal death in this case.