title: Intrauterine fetal death after multiple umbilical cord torsion-complication of a twin pregnancy following assisted reproduction.
abstract: BACKGROUND
  Patients requiring assisted reproductive techniques may have a higher rate of congenital malformations. Some rare complications of pregnancy might be related to such abnormalities. Torsions of the umbilical cord resulting in fetal death have previously been described exclusively in pregnancies following spontaneous conception.
  
  
  METHODS
  The case of 37 year old gravida I, para O woman with a twin pregnancy after intracytoplasmatic sperm injection and intrauterine death of one twin at approximately 30 weeks' gestation is presented. The surviving twin was delivered by cesarean section at 31 weeks after spontaneous onset of labor and recurrent fetal bradycardia. The intraoperative situs showed that the demised twin had suffered from multiple umbilical cord torsions leading to intrauterine hypoperfusion.
  
  
  CONCLUSIONS
  Umbilical torsion leading to fetal death might represent a previously unrecognized complication in women requiring assisted reproductive techniques, but this problem is known to occur in pregnancies achieved by natural methods.
authors.affiliation: Department of Obstetrics and Gynecology, Heinrich-Heine-University, Duesseldorf, Germany.
authors.forename: M C
authors.initials: MC
authors.lastname: Fleisch
authors.forename: Thomas
authors.initials: T
authors.lastname: Hoehn
mesh_terms: D000328:Adult; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005313:Fetal Death / Q000209:etiology* / Q000473:pathology; D005315:Fetal Diseases / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000473:pathology; D011272:Pregnancy, Multiple / Q000502:physiology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D054159:Torsion, Mechanical; D014427:Twins; D014470:Umbilical Cord / Q000473:pathology*