Fetal Death Associated with Pathological Hypercoiling and Torsion of the Umbilical Cord: A Case Report
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Abstract
Introduction: Hypercoiling of the umbilical cord is a rare cause of intrauterine fetal death. Most reported cases include thrombosis or inflammation, making vascular obliteration without these findings unusual and clinically relevant. Objective: To present a case of intrauterine fetal death due to hypercoiling and torsion of the umbilical cord, highlighting uncommon clinical and histopathological findings. Case report: A 28-year-old woman with chronic hypertension and overweight, with irregular prenatal care, presented with absence of fetal movements accompanied by anxiety and insomnia. Ultrasound confirmed fetal demise at 27 weeks with oligohydramnios. Labor was induced with misoprostol, resulting in a female fetus weighing 990 grams, with abdominal necrosis and ecchymosis. The umbilical cord measured 66 cm, showed 39 twists, torsion, and constriction at the fetal insertion. Histopathological examination revealed obliteration of two arteries and one vein without thrombosis or inflammation. The patient had a favorable postpartum course without maternal complications and received psychological support and reproductive counseling. Conclusions:This case confirms that severe hypercoiling with torsion can cause intrauterine fetal death even in the absence of thrombosis. It underscores the need for systematic placental and umbilical cord examination in cases of fetal demise, reinforcement of timely prenatal care, and comprehensive support for affected patients.
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References
I. Slack, J. C., Boyd, T. K., & Carreon, C. K. (2022). Recurrent Second Trimester Fetal Demise Caused by Hypercoiled Umbilical Cords. Fetal and Pediatric Pathology, 42(3), 492–497. https://doi.org/10.1080/15513815.2022.2142490
II. Tuania, A., Cecchi, A., Carboni, E., Resta, S., Bonasoni, M. P., & Ruano, R. (2023). Umbilical cord abnormalities and pregnancy outcome: A narrative review. Healthcare, 11(19), 2634. https://doi.org/10.3390/healthcare11192634
III. Moyano, G., García, R., Barrera, C., & Corsi, O. (2022). Hiperenrollamiento con torsión del cordón umbilical como causa de muerte fetal: reporte de caso. Revista Chilena de Obstetricia y Ginecología, 87(2), 158-165. https://doi.org/10.4067/S0717-75262022000200158
IV. Nakamura, M., Hasegawa, J., Takita, H., & Sekizawa, A. (2021). Amnioinfusion and bed rest may effectively improve the insufficient circulation of the umbilical cord in pregnant women with hyper-coiled cord and oligohydramnios. Journal of Medical Cases, 12(1), 1–4
https://doi.org/10.14740/jmc3581
V. Akgün, N., Köflüfl, N., Köflüfl, A., & Yard›mc›, F. (2016). Umbilical cord stenosis and umbilical cord torsion: A case report. Perinatal Journal, 24(1), 47–50. https://doi.org/10.2399/prn.16.0241009
VI. Valera Rodríguez, N., Castro, C. S., Martínez Navarro, J., Fumero Roldán, L., & Rodríguez León, J. E. (2024). Alteraciones de la placenta y sus anejos en muestras procedentes de muertes fetales. Medisur, 22(1). https://doi.org/10.5281/zenodo.10649334
VII. Dutman, A. E., Nikkels, P. G. J., Koek, G. H., van de Vosse, E., & Oepkes, D. (2015). Umbilical hypercoiling in second- and third-trimester intrauterine fetal death. Pediatric and Developmental Pathology, 18(2), 81–87. https://doi.org/10.2350/14-07-1527-OA.1
VIII. Ernst, L. M., Minturn, L., Huang, M. H., Curry, E., Su, E. J., & Miller, E. S. (2013). Gross patterns of umbilical cord coiling: Correlations with placental histology and stillbirth. Placenta, 34(7), 583–589. https://doi.org/10.1016/j.placenta.2013.04.011
IX. Singireddy, A., Patnaik, S., Bera, R., & Dash, S. S. (2023). Antenatal evaluation of umbilical coiling index and its correlation with perinatal outcome. Journal of Clinical and Diagnostic Research, 17(12), QC01–QC05.
https://doi.org/10.7860/JCDR/2023/62554.1838
X. Slack, J. C., Boyd, T. K., & Carreon, C. K. (2023). Recurrent second trimester fetal demise caused by hypercoiled umbilical cords. Fetal and Pediatric Pathology, 42(3), 492–497.
https://doi.org/10.1080/15513815.2022.2142490
XI. Clement, A., Mendoza, A., Wixom, C., & Zhang, P. (2025). Umbilical cord hypercoiling with stricture and intrauterine fetal death: Association with maternal factors and implications for pathogenesis. Fetal and Pediatric Pathology, Advance online publication.