INTRA-PARTUM FETAL DEATH DUE TO THROMBOSIS OF THE DUCTUS VENOSUS - A CLINICOPATHOLOGICAL CASE-REPORT

Thrombosis of the umbilical cord vessels is a rare but life-threatenin g event, usually leading to the death of the fetus. This report presen ts a case of an intra-partum fetal death due to thrombosis of the duct us venosus, hitherto not described in the literature. Labour was induc ed with intravenous oxytocin in a 21-year-old nulliparous woman becaus e of postmaturity at 43 weeks gestation. Abrupt fetal bradycardia deve loped at 5 cm dilatation and fetal demise occurred within minutes with out any sign of abruptio placentae or uterine hyperactivity. A cesarea n section was performed because of failure to deliver the macrosomic f etus by vacuum extraction. On autopsy a fresh occlusive thrombus was f ound at the beginning of the ductus venosus in the portal sinus. Mater nal and fetal risk factors known to be associated with umbilical cord thrombus formation were excluded. Repeated assessment of Bishop scores is thought to have caused local infection of the membranes at the int ernal cervical os, resulting in general amnionitis and vasculitis of t he umbilical cord, Secondary to the infection thrombus formation took place either primarily in the portal sinus and ductus venosus or in th e umbilical vein with subsequent detachment and embolisation into the portal sinus, therewith occluding the ductus venosus leading to fetal death.