Umbilical Cord Stricture in a 21-Week Fetus

Umbilical Cord Restructure: An Uncommon Cause of Intrauterine Fetal Death.

“…The reported frequency of UCS is very varied and ranges from 6% to 20% of all perinatal autopsies (3). For the most of the authors it has no predilection for race, parity, gestational age, or fetal sex (2). It is easy to recognize on gross examination 3).…”

“…It is easy to recognize on gross examination 3). It can occur anywhere along the UC length, but it occurs most commonly at the extreme fetal end (1,2,6). It can be independent or associated with other cord anomalies,such as hypocoiling, hypercoiling, torsion, thinning, or excessive length (1,3,6).…”

“…It can be independent or associated with other cord anomalies,such as hypocoiling, hypercoiling, torsion, thinning, or excessive length (1,3,6). On the microscopic examination there is a lack of Wharton's jelly and an abundance of fibrosis at the site of the stricture, vessels that are compressed or narrowed, occasionally with thrombosis (1).The genetic or environmental causes remain unknown (2,3). Several theories explaining the pathogenesis of this condition have been considered, but actually the theory of a primary deficiency of Wharton's jelly with secondary compression or obstruction is the most accepted (2,3).…”

“…The causal link UCS and IUFD has long been established (1,(3)(4)(5). Most IUFD attributed to UCS are seen at 6-month to 9-month of gestation (1,6 ), but UCS occurs early in gestation, while the fetus is still small (2,4). The narrowing of the blood vessels within the UCS area causes a decrease in the blood flow to the fetus.…”

“…The narrowing of the blood vessels within the UCS area causes a decrease in the blood flow to the fetus. As the fetus grows, decreased umbilical blood flow fails to meet the demands of the developing fetus, the fetus develops IUGR, becomes hypoxic and then acidotic, and IUFD follows (1,2,4). Even the UCS has been traditionally considered a sporadic anomaly, the risk of recurrence is undetermined in the available data, it varies from very low to increased risk (1,(3)(4)(5).…”