Intrauterine Fetal Demise

2020 ◽  
Author(s):  
Gianna L Wilkie ◽  
Sarah E Little
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Umbilical Cord ◽  
Fetal Death ◽  
Genetic Evaluation ◽  
Placental Pathology ◽  
Fetal Demise ◽  
Maternal History ◽  
Intrauterine Fetal Demise ◽  
Delivery Planning

Intrauterine fetal demise (IUFD) and stillbirth are interchangeable terms to describe a fetal death in the second half of pregnancy. IUFD is defined as the delivery of a fetus showing no signs of life as indicated by the absence of heart rate, breathing, umbilical cord pulsation, or voluntary muscle movements. A thorough evaluation of maternal history and risk factors, fetal evaluation involving autopsy and genetic evaluation, and placental pathology should be offered at the time of IUFD diagnosis. Significant counseling should be provided to patients regarding future pregnancies and the risk of recurrence as well as the need for increased antenatal testing and delivery planning in subsequent pregnancies.  This review contains 5 tables, 10 figures and 55 references.  Keywords: fetal kick counts, intrauterine fetal demise (IUFD), management of intrauterine fetal demise, microarray, placental pathology, risk factors for intrauterine fetal demise

scholarly journals Umbilical true knot: a case study

2018 ◽  
Vol 7 (7) ◽  
pp. 2956
Author(s):  
Hima Bindu Kommuri ◽  
Valsa Diana G.
Keyword(s):  
Risk Factors ◽  
Umbilical Cord ◽  
Rare Condition ◽  
Fetal Outcome ◽  
Prenatal Ultrasonography ◽  
Male Fetus ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
Fetal Movements

Umbilical cord true knot is a rare condition which affects about 1% of all pregnancies. The incidence is not only very low, but it is often undiagnosed antenatally when present despite the availability of prenatal ultrasonography as in this case, where the diagnosis of true knot of umbilical cord was missed even when an ultrasonogram was done 1 week prior to the presentation of patient with decreased fetal movements to opd. Majority of times it does not have any relation with fetal outcome but in certain occasions it is associated with intrauterine fetal demise as in present case presented here. Risk factors include long umbilical cord, polyhydramnios, small fetus, male fetus, etc.

Umbilical Cord Lesions in Early Intrauterine Fetal Demise

2003 ◽  
Vol 127 (7) ◽  
pp. 850-853 ◽  
Author(s):  
Vivekanand Singh ◽  
Sufia Khanum ◽  
Meenal Singh
Keyword(s):  
Umbilical Cord ◽  
Spontaneous Abortions ◽  
Fetal Demise ◽  
Amniotic Band ◽  
Early Gestation ◽  
Intrauterine Fetal Demise ◽  
Products Of Conception ◽  
Medical Induction ◽  
Umbilical Cords ◽  
Routine Assessment

Abstract Context.—The cause for intrauterine fetal demise (IUFD) occurring in early gestation in a high percentage of spontaneous abortions is unknown. Objective.—To determine the association, if any, of umbilical cord abnormalities with early IUFD. Design.—All cases of IUFD occurring within 16 weeks of gestation that presented to our hospitals between August 1998 and July 2001 were prospectively studied. Once the fetal demise was diagnosed, pregnancy was terminated by medical induction, such that the products of conception were largely delivered intact. Cases with an intact umbilical cord connecting the fetus and placenta were considered in the study, whereas disrupted cord and curettage material was excluded from the study. Results.—A total of 153 early IUFD cases were seen during the period of study. The medical induction yielded intact products of conception in 122 cases, whereas 31 cases had to be completed by curettage, as the expulsion of the conceptus was incomplete. Thirteen of the 122 IUFD cases showed abnormalities of the umbilical cord. The cord lesions most frequently encountered were constriction and coiling abnormalities. Other lesions seen included hemorrhage, thrombosis, edema, and amniotic band. Conclusions.—A significantly high number (10.7%) of IUFD in early gestation are associated with umbilical cord abnormalities. Routine assessment of umbilical cords in early pregnancy might help to detect pregnancies at risk.

Fetal Vascular Malperfusion Due To Long and Hypercoiled Umbilical Cords Resulting in Recurrent Second Trimester Pregnancy Loss: A Case Series and Literature Review

2020 ◽  
pp. 109352662096206
Author(s):  
Jonathan C Slack ◽  
Theonia K Boyd
Keyword(s):  
Umbilical Cord ◽  
Rare Event ◽  
Case Series ◽  
Second Trimester ◽  
Fetal Demise ◽  
Flow Restriction ◽  
Intrauterine Fetal Demise ◽  
Increased Risk ◽  
Second Trimester Pregnancy ◽  
Umbilical Cords

Background Intrauterine fetal demise due to fetal vascular malperfusion in mid-gestation is a rare occurrence. Abnormally long and hypercoiled umbilical cords are associated with an increased risk of umbilical cord blood flow restriction, which in turn can result in adverse perinatal and maternal outcomes. The factors that regulate umbilical cord development, specifically umbilical cord length and coiling, are poorly understood. Methods Maternal history, along with fetal and placental findings (post-mortem, pathological, and molecular), were reviewed for a series of 3 consecutive pregnancies that ended in second trimester intrauterine fetal demise. Results All 3 umbilical cords were exceptionally long and hypercoiled, and all placentas showed evidence of high-grade fetal vascular malperfusion. At fetopsy, all 3 fetuses were developmentally normal for gestational age and lacked congenital anomalies. Maternal medical history and antenatal testing (including an extensive work-up for maternal hypercoagulability syndromes) were normal and/or noncontributory. Conclusion Although excessively long and hypercoiled cords are generally thought of as sporadic, nongenetic events, rare examples of recurrent intrauterine fetal demise secondary to such exist have been reported. This intrafamilial clustering of a rare event is suggestive that at least a subset of hypercoiled, long umbilical cords may have an underlying genetic etiology.

scholarly journals Intraplacental Leiomyoma in a Case of Second-Trimester Intrauterine Fetal Demise

2020 ◽  
Vol 13 ◽  
pp. 2632010X2092832
Author(s):  
Selene C Koo ◽  
Fang Bu
Keyword(s):  
Smooth Muscle ◽  
Umbilical Cord ◽  
Incidental Findings ◽  
Adverse Outcome ◽  
Implantation Site ◽  
Rare Tumor ◽  
Second Trimester ◽  
Histological Findings ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise

Intraplacental leiomyomas are extremely rare and are generally incidental findings in term placentas. We present the first reported case of a placental leiomyoma associated with preterm intrauterine fetal demise, with histological findings providing the cause of adverse outcome. This was an intrauterine fetal demise detected at 26 weeks gestation with a placental finding of a 2.8-cm leiomyoma. Histological findings in the placenta and fetus were consistent with intrauterine fetal demise of weeks. The umbilical cord was markedly hypercoiled, with 6 twists per 10 cm. Features of maternal vascular malperfusion were evident in the placenta, including villous hypermaturity, an infarct adjacent to the leiomyoma, and retention of smooth muscle in spiral arterioles within the decidua overlying the leiomyoma. Implantation-site trophoblasts invaded into the leiomyoma and the overlying decidua. We hypothesize that incorporation of the leiomyoma into the placenta contributed to fetal demise due to disordered placental implantation, implying that these tumors may not be as benign and incidental as previously described. The finding of implantation-site changes in the leiomyoma may also suggest a potential cause for this rare tumor.

scholarly journals VP29.08: Dichorionic twin pregnancy complicated by duodenal atresia and umbilical cord ulceration with intrauterine fetal demise

2021 ◽  
Vol 58 (S1) ◽  
pp. 219-219
Author(s):  
E. Krispin ◽  
D.J. Danner ◽  
R.V. Donepudi ◽  
M.A. Belfort ◽  
M. Fuller ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Twin Pregnancy ◽  
Duodenal Atresia ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise

Abnormal Umbilical Cord Coiling is Associated with Adverse Perinatal Outcomes

2000 ◽  
Vol 3 (5) ◽  
pp. 462-471 ◽  
Author(s):  
Geoffrey A. Machin ◽  
Jeanne Ackerman ◽  
Enid Gilbert-Barness
Keyword(s):  
Umbilical Cord ◽  
Growth Retardation ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Neurological Status ◽  
Adverse Outcomes ◽  
Placental Pathology ◽  
Fetal Demise ◽  
Fetal Death Rate ◽  
Clinical Correlations

The normal umbilical cord coil index is one coil/5 cm, i.e., 0.2 ±0.1 coils completed per cm. We report the frequency and clinical correlations of abnormally coiled cords among 1329 cases referred to our placental pathology services. Twenty-one percent of cords were over-coiled and 13% were undercoiled. Abnormal cord coiling was seen at all gestational ages. Principal clinical correlations found in overcoiled cords were fetal demise (37%), fetal intolerance to labor (14%), intrauterine growth retardation (10%), and chorioamnionitis (10%). For undercoiled cords, the frequencies of these adverse outcomes were 29%, 21%, 15%, and 29%, respectively. Abnormal cord coiling was associated with thrombosis of chorionic plate vessels, umbilical venous thrombosis, and cord stenosis. Thus, abnormal cord coiling is a chronic state, established in early gestation, that may have chronic (growth retardation) and acute (fetal intolerance to labor and fetal demise) effects on fetal well-being. The cause of abnormal cord coiling is not known. Its effects on neurological status of survivors are also unknown. Antenatal detection of abnormal cord coil index by ultrasound could lead to elective delivery of fetuses at risk, thereby reducing the fetal death rate by about one-half. We recommend that the cord coil index become part of the routine placental pathology examination.

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