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Paper Title: Umbilical cord torsion with intrauterine fetal death in a multipara with two previous Caesarean sections: A Case Report

Authors: Abam D.S, Eli S. , Kalio D.G.B, NWOSU C.C

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Umbilical cord torsion and other cord accidents are causes of perinatal morbidity and mortality. Umbilical cord torsion accounts
for a 4-fold increase in perinatal death.

The aim of this paper is to present a rare clinical entity and create awareness on its management modalities.

Case Report:
Mrs. P.O. a 39 year old G4 para 2+1 (2 alive) with two previous caesarean sections presented at the antenatal clinic at 36
weeks gestation with a 2-day history of absence of fetal movement. Intrauterine fetal demise was confirmed via a sonogram. The
antenatal period was before now uneventful. She was diagnosed with an unexplained intrauterine fetal death; and subsequently
had an elective repeat caesarean section. At surgery, the fetal death was strongly suspected to have resulted from torsion of the
umbilical cord. Her post-operative period was uneventful. She was discharged on the 7th post-operative day.

Due to the emotional pain expressed by parturients with antenatal fetal death, mostly in those in whom the cause of death is
uncertain and unexpected, we recommend that more steps be employed in antepartum fetal surveillance, including the use of
Doppler, which may pick up some vascular disorders that may increase the predictability of intrauterine fetal death. However,
in resource poor countries the acquisition of these tools may still seem far-fetched.

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