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Fetus

Poster Session 3

(917) Incidence of umbilical cord accidents as a cause of fetal death and associated histologic characteristics

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The underlying mechanisms of umbilical cord accidents (UCA) as the cause of fetal death are poorly understood. We aim to report the incidence of fetal death due to UCAs at a large, urban hospital and identify the associated histologic characteristics.  

Study Design: This is a retrospective cohort study of all singleton fetal deaths ≥ 24 weeks that were attributed to umbilical cord accidents at a large, urban health system that serves medically-indigent patients. Each fetal death underwent a complete cause of death analysis by a multi-disciplinary committee of neonatologists, genetic counselors, obstetricians, and pathologists. Diagnosis of fetal death due to umbilical cord accidents was made by committee consensus opinion after review of the antepartum pregnancy course, fetal autopsy, chromosomal microarray, placental pathology, and fetal surveys.  The placental slides for each case were reviewed by two pathologists and a consensus report was issued. The pathology reports were systematically reviewed and tabulated.

Results: Between January 2010 and December 2022 there were 150,090 singleton births at our facility, 782 of which were fetal deaths ≥ 24 weeks and weighing ≥ 500 grams at delivery. After case review by the committee, 31 (4%) of the fetal deaths were attributed to umbilical cord accidents. Fetal survey at time of delivery and subsequent pathologic cord evaluation was notable for a nuchal cord in 15 patients (48.4%), a true knot in 7 patients (22.6%), and cord hyper-coiling in 7 patients (22.6%) (Table). Placental pathology was notable for vasculopathy in 16 patients (51.6%) and villitis in 7 patients (22.6%) (Table).

Conclusion: Umbilical cord abnormalities are an important risk factor for stillbirth. Umbilical cord accidents account for approximately 4% of fetal deaths at a large urban hospital system. Associated histologic findings include cord hyper-coiling, placental vasculopathy, and placental villitis.