P30.16: Hipercoiling of the umbilical cord associated with the fetal death

Introduction: Hipercoiling of the umbilical cord and fetal-placental thrombotic vasculopathy are well know conditions but sometimes undervalued as a cause of adverse perinatal outcome. Like about several other placental lesions, the difficulty arise in the lack of routine practice of always correlate the clinical and ultrasound findings with the placental pathology, as illustrated in this case. Case report: A caucasian, 38 years old, primiparous and married patient, residing at Vitoria, Espírito Santo Sate, Brazil. In December 2008 showed positive beta-HCG and initiated prenatal care; the labor was scheduled to 06/08/09. During pregnancy, did follow-up clinical, laboratory and routine ultrasound, without maternal or fetal abnormality. However, on 17/07/09, with 36 weeks of gestation, a routine ultrasound revelead fetal death. The delivery occurred at the same day. At autopsy, it was found that fetal death occurred 12 to 24 hours before termination, and the findings were diagnostics of fetal growth restriction (fetal weight of 2027 g, z/IG: − 1.9, and the liver, kidney and thymus was of reduced in size), long (720 mm, z/IG: 3.9) and hipercoiling cord (UCI: 0.56, VR 0.10 A 0.30), diffuse villous immaturity, extensive alantochorial and chorial thrombosis, hemorrhagic endovasculopathy and Altshuler stage 2, grade 1 chorioamnionitis, involving extra-placental membranes and placenta. Comments: This case stands out, curiously, by the contrast between the absence of detectable clinical and ultrasonographic manifestations and the exuberance of pathological lesions. We recommend that the umbilical cord coil index become part of the routine fetal anatomic survey in the second trimester ultrasonography.