Loss of Wharton's jelly and fibrosis in umbilical cord stricture area: A case report

Abstract

Introduction: Stricture of the umbilical cord, though a rare condition, is one of the critical events that can be associated with intrauterine fetal death.

Case: A 27-year-old woman, primigravida, presented with USG report of fetus mortus at 37 weeks of gestation. There were no preceding warning signs. Postmortal examination showed Grade II macerated female fetus weighing 2372 g, measuring 49 cm, with haemorrhagic fluid in the brain ventricles. Microscopically, there were signs of amniotic fluid aspiration and autolytic changes. The macroscopic placental examination was normal, while signs of intrauterine asphyxia and intrauterine fetal demise were present histologically. Umbilical cord insertion was eccentric, on the cut three-vessel cord, 49 cm long, 1 cm in diameter. Extremely narrow segment measured 3 mm, approximately 1,5 cm in length, and was located 1 cm from fetal insertion site. In the further course, hypercoiling in 12 cm of the length was present. Examination of umbilical cord in stricture area revealed loss of Wharton's jelly, replacement with extensive fibrosis and capillary vessel formation.

Discussion and conclusion: The causality between umbilical cord stricture and intrauterine fetal demise has been established. Etiology is still unclear, therefore postmortal examination with umbilical cord evaluation and further research are needed.

Keywords: Fetal demise; Loss of Wharton's jelly; Umbilical cord hypercoiling; Umbilical cord stricture; Wharton's jelly fibrosis.