UMBILICAL CORD THROMBOSIS: A METICULOUS CULPRIT OF INTRAUTERINE FETAL DEMISE

Samantha Stancu MD*, Cristian Poalelungi MD, PhD, Bogdan Carabas MD, Manuela Russu MD, PhD Professor of Obstetrics and Gynaecology

ABSTRACT

Introduction: Intrauterine fetal demise (IUFD) is the most dramatic and often unpredictable pregnancy complication. Sixty percent of cases remain idiopathic despite numerous pathophysiological entities described in literature. The objective of this study was to identify potential risk factors and causes of IUFD. Materials and Methods: A retrospective, observational study conducted on pregnant women, who experienced a fetal loss at gestational age ≥ 24 weeks and birth weight ≥ 500 grams, at the Obstetric Discipline of Dr. I Cantacuzino Hospital. Data concerning demographics, maternal-associated pathology, delivery, fetal gender and birth weight, as well as autopsy findings were procured for the period between January 1, 2013 and December 31. Statistical analysis was carried out using GraphPad Prism with statistical significance set at p<0.05. Results and Discussion: Forty-three fetal losses were recorded in women ages 16-42 (average age 28.2 ± 6.4 years). Twelve mothers (27.9%) consented to fetal autopsy, which revealed the following causes of death: umbilical cord thrombosis (n=7, 63.9%), subchorionic thrombosis (n=2, 18.2%) and vasa praevia (n=2, 18.2%). Negative Docimasia tests placed time of death as antepartum in all autopsied fetuses. Cerebral hemorrhage was the most frequent autopsy finding (n=8, 72.7%). The following risk factors for umbilical cord thrombosis were identified: previous Caesarean Section (p=0.0006), lack of pregnancy monitoring (p=0.0006) and excessive gestational weight gain (p=0.003). Conclusion: Umbilical cord thrombosis is an increasingly frequent cause of spontaneous IUFD. Multicentric randomized controlled trials are needed to establish guidelines for anticoagulation in pregnancy. All pregnant women with abnormal coagulation parameters should be screened for thrombophilia.

Keywords: intrauterine fetal demise, umbilical cord thrombosis, autopsy.