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* Context-The cause for intrauterine fetal demise (IUFD) occurring in early gestation in a high percentage of spontaneous abortions is unknown.
Objective.-To determine the association, if any, of umbilical cord abnormalities with early IUFD.
Design-All cases of IUFD occurring within 16 weeks of gestation that presented to our hospitals between August 1998 and July 2001 were prospectively studied. Once the fetal demise was diagnosed, pregnancy was terminated by medical induction, such that the products of conception were largely delivered intact. Cases with an intact umbilical cord connecting the fetus and placenta were considered in the study, whereas disrupted cord and curettage material was excluded from the study.
Results-A total of 153 early IUFD cases were seen during the period of study. The medical induction yielded intact products of conception in 122 cases, whereas 31 cases had to be completed by curettage, as the expulsion of the conceptus was incomplete. Thirteen of the 122 IUFD cases showed abnormalities of the umbilical cord. The cord lesions most frequently encountered were constriction and coiling abnormalities. Other lesions seen included hemorrhage, thrombosis, edema, and amniotic band.
Conclusions-A significantly high number (10.7%) of IUFD in early gestation are associated with umbilical cord abnormalities. Routine assessment of umbilical cords in early pregnancy might help to detect pregnancies at risk.
(Arch Pathol Lab Med. 2003;127:850-853)
The role of umbilical cord abnormalities in causing intrauterine fetal demise (IUFD) has never received its due emphasis. Although there are many case reports and series studies that have identified cord anomalies as the direct cause of fetal death, exclusive prospective studies to evaluate the role of cord abnormalities in fetal death are rare. In part, the problem of studying the umbilical cord lies in the fact that it is difficult to procure an intact cord and still more difficult to obtain a gestational sac with the fetus and placenta connected by intact cord. More than 80% of all abortions occur in the first trimester, and 53% of these are attributable to chromosomal abnormalities.1 The cause of abortion in 45% of cases is unknown. Similarly, the cause of abortions in the early second trimester is unknown in a vast majority of cases. Therefore, we sought to evaluate the role of cord complications in IUFD during...