Umbilical cord torsion leading to intrauterine fetal death

Abstract

The umbilical cord is the critical organ that links the placenta and fetus. The intrauterine conditions and fetal activity influences the umbilical cord length. The normal umbilical cord is spiraled. By ultrasound, the spiral nature of the umbilical cord can be demonstrated early in the first trimester. Most of the adverse pregnancy and perinatal outcomes are related to abnormal Umbilical Cord coiling Index (UCI). A 23 year booked G2P1+0 of about 4/12 pregnant is presented. She presented 4 h history of colicky lower abdominal pain and 1 h history of vaginal bleeding; there were passage of blood clot but no fleshy materials or vesicles. No history of urinary symptoms or trauma, she is not a known Diabetics, hypertensive or sickle cell diseases patient. On examination, was not in painful distress, not pale, afibrile (36.9°C), anecteric and no fedal edema. Other parameters were within normal limit. Pelvic examination reveals a vulva smeared with blood, the fetal membrane were bulging into the vagina, this rupture spontaneously, and the cervix was fully dilated. She was managed for inevitable abortion; she subsequently expelled a female abortus. The abortus and the placenta were taken for histology which shows ischemic infarction on the placental tissue and hyper coiling of the umbilical cord. She was placed on anti-malaria, antibiotics and heamatenics, and was discharged home for follow-up. Modern imaging techniques are useful in the evaluation of Umbilical Cord coiling Index especially during the second trimester. To predict the adverse prenatal and pregnancy outcomes with view of instituting appropriate measures to obviate them, therefore routine screening for the high index cases is suggested.  Keywords: Umbilical cord, coiling index, torsion, intrauterine fetal death (IUFD).