Fetal Death Associated with Pathological Hypercoiling and Torsion of the Umbilical Cord: A Case Report

Introduction: Hypercoiling of the umbilical cord is a rare cause of intrauterine fetal death. Most reported cases include thrombosis or inflammation, making vascular obliteration without these findings unusual and clinically relevant. Objective: To present a case of intrauterine fetal death due to hypercoiling and torsion of the umbilical cord, highlighting uncommon clinical and histopathological findings. Case report: A 28-year-old woman with chronic hypertension and overweight, with irregular prenatal care, presented with absence of fetal movements accompanied by anxiety and insomnia. Ultrasound confirmed fetal demise at 27 weeks with oligohydramnios. Labor was induced with misoprostol, resulting in a female fetus weighing 990 grams, with abdominal necrosis and ecchymosis. The umbilical cord measured 66 cm, showed 39 twists, torsion, and constriction at the fetal insertion. Histopathological examination revealed obliteration of two arteries and one vein without thrombosis or inflammation. The patient had a favorable postpartum course without maternal complications and received psychological support and reproductive counseling. Conclusions:This case confirms that severe hypercoiling with torsion can cause intrauterine fetal death even in the absence of thrombosis. It underscores the need for systematic placental and umbilical cord examination in cases of fetal demise, reinforcement of timely prenatal care, and comprehensive support for affected patients.