Prevention of stillbirths associated with umbilical cord abnormalities: A clinico‐pathological overview

Stillbirths affect millions of pregnancies every year worldwide, and obstruction of the umbilical cord blood flow is one of the main causes of fetal death. This review provides a clinico-pathological overview of cord abnormalities potentially associated with antepartum stillbirth, describing the mechanism determining the death and addressing suggestions about the possibility of stillbirth prevention. Fatal effects on the fetal circulatory system can occur due to various umbilical cord abnormalities, both in cases of acquired anomalies (i.e., multiple tight nuchal cords and true knots) or congenital anomalies (i.e., aneurysmatic malformation, stricture, abnormalities of cord insertion in the fetal or placenta site such as velamentous or furcate cord insertion). In pregnancies with an identification of umbilical cord abnormality, ultrasound signs of fetal well-being could be monitored over time. Although close monitoring cannot prevent a sudden lethal obstruction of umbilical cord vessels, it could identify the development of long-lasting signs of fetal decompensation, possibly preventing fetal death.