title: Umbilical cord hypercoiling and thinning: a rare cause of intrauterine death in the second trimester of pregnancy.
abstract: Little attention has been paid to the pathologic features of the umbilical cord, which might fatally damage the fetus. We determined the association of hypercoiling (more than 1 coil per 5 cm) and thinning with consecutive constriction of the umbilical vessels (thin cord syndrome; TCS) and intrauterine fetal death (IUFD). Three hundred and three cases of consecutive fetal autopsies over a 5-year period, including spontaneous and induced abortions of the 2nd trimester of pregnancy, were examined using a standardized protocol. The mean maternal age was 28.5 years and the mean gestational age was 19.1 weeks (range: 12.6 to 24.5 weeks). Thirty-six percent of all cases were induced abortions because of congenital malformations, and 8.9% resulted from legal abortions, as regulated by German law. One hundred sixty-seven cases (55.1%) were spontaneous abortion specimens. The leading cause for IUFD in the spontaneous abortion group was an amnion infection (34.7%), followed by abruptio placentae (15.6%). In 25.1% of cases, placental dysmaturity with consecutive placental insufficiency was responsible for IUFD. Pathologies of the umbilical cord as the cause of IUFD were seen in 10.2% of the cases. Most of these cases (15/17) involved TCS. In 14.4% of all spontaneous abortion specimens the cause of IUFD could not be determined by autopsy. There was an apparent difference in the frequency of TCS in the spontaneous abortion group (15/167 = 9%) compared to the nonspontaneous group (2/136 = 1.5%). A remarkably high percentage (17/303 = 5.6%) of all cases showed TCS. In cases of spontaneous abortions, TCS was causative for intrauterine death in 9% of cases (15/167). Careful pathologic examination of the umbilical cord is recommended to detect TCS and to reduce the cases with unexplained intrauterine death.
authors.affiliation: Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany. hornl@medizin.uni-leipzig.de
authors.forename: Lars-Christian
authors.initials: LC
authors.lastname: Horn
authors.forename: Renaldo
authors.initials: R
authors.lastname: Faber
authors.forename: Holger
authors.initials: H
authors.lastname: Stepan
authors.forename: Eike
authors.initials: E
authors.lastname: Simon
authors.forename: Ralf
authors.initials: R
authors.lastname: Robel
authors.forename: Christian
authors.initials: C
authors.lastname: Wittekind
mesh_terms: D037881:Aborted Fetus / Q000098:blood supply / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D003251:Constriction, Pathologic / Q000150:complications / Q000401:mortality / Q000473:pathology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D010922:Placenta Diseases / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D014470:Umbilical Cord / Q000002:abnormalities* / Q000473:pathology