Intra-partum fetal death due to thrombosis of the ductus venosus: a clinicopathological case report

Abstract

Thrombosis of the umbilical cord vessels is a rare but life-threatening event, usually leading to the death of the fetus. This report presents a case of an intra-partum fetal death due to thrombosis of the ductus venosus, hitherto not described in the literature. Labour was induced with intravenous oxytocin in a 21-year-old nulliparous woman because of postmaturity at 43 weeks gestation. Abrupt fetal bradycardia developed at 5 cm dilatation and fetal demise occurred within minutes without any sign of abruptio placentae or uterine hyperactivity. A cesarean section was performed because of failure to deliver the macrosomic fetus by vacuum extraction. On autopsy a fresh occlusive thrombus was found at the beginning of the ductus venosus in the portal sinus. Maternal and fetal risk factors known to be associated with umbilical cord thrombus formation were excluded. Repeated assessment of Bishop scores is thought to have caused local infection of the membranes at the internal cervical os, resulting in general amnionitis and vasculitis of the umbilical cord. Secondary to the infection thrombus formation took place either primarily in the portal sinus and ductus venosus or in the umbilical vein with subsequent detachment and embolisation into the portal sinus, therewith occluding the ductus venosus leading to fetal death.