A case of intrauterine fetal death due to umbilical cord thrombosis in a fetal posterior cloacal anomaly with ascites and large hydrocolpos

Abstract

 Umbilical cord thrombosis is associated with poor perinatal outcome. We report a case of fetal posterior cloacal anomaly with ascites that resulted in fetal death due to umbilical cord thrombosis. A pregnant woman was diagnosed with fetal ascites at 25 weeks’ gestation and was referred to our hospital. Ultrasound showed fetal ascites and an irregular cyst on the dorsal side of the bladder. We suspected the cyst was hydrometra and hydrocolpos, and diagnosed the fetus had cloacal anomaly. From 30 weeks’ gestation, increased fetal ascites, enlarged cyst and oligohydramnios were gradually apparent. To prevent severe pulmonary hypoplasia, 320 ml of fetal ascites was removed at 34 weeks 0 days of gestation. Intrauterine fetal death occurred at 35 weeks 5 days of gestation and a 2,430 g girl was stillborn 2days later. Pathological autopsy confirmed posterior cloacal anomaly, hydrometra, pulmonary hypoplasia, unilateral renal atrophy and esophageal atresia（Gross C type）. Placental pathology revealed an umbilical cord thrombosis, which was considered to be the main cause of fetal death. A cloacal anomaly with ascites, large hydrocolpos and oligohydramnios may have the possibility of thrombosis formation and fetal death. Therefore, careful examination in placenta and umbilical cord in such cases are important.