CONSTRICTION OF THE UMBILICAL-CORD LEADING TO FETAL DEATH - A REPORT OF 3 CASES

Constriction of the umbilical cord is characterized by localized absen ce of Wharton's jelly, lending to narrowing of the cord, thickening of the vascular walls and narrowing of the vascular lumens. This may res ult in a compromised fetal blood supply, lending to fetal anoxia and e ventual fetal death. Approximately 50 cases have been reported in the world literature over the last three centuries. Three cases of umbilic al cord constriction leading to intrauterine fetal demise are reported . Two of the patients presented during the late second trimester with loss of sensation of fetal movements. Intrauterine fetal demise was di agnosed, and autopsy revealed constricted umbilical cords associated w ith torsion. The third patient is unique in that fetal death was preci pitated by a routine, technically uncomplicated, transplacental amnioc entesis procedure performed in the early second trimester. At the time of termination of the pregnancy we found marked stenosis with torsion over a 1-cm segment of the umbilical cord juxtaposed against the feta l insertion site. Umbilical cord constriction is a rare, almost invari ably fatal condition, usually undiagnosed antenatally. In case 3, disr uption of the placenta by amniocentesis may have initiated a terminal event in a fetus already compromised by a cord constriction. Three pos sible mechanisms could have contributed to the fetal death after amnio centesis in the presence of cord constriction: acute vasospasm, acute oligohydramnios and uterine contraction, or an obliterating thrombus.