Fetal Death Due to an Unusual Coexistence of Two Umbilical Cord Anomalies: Analysis in a Forensic Perspective.

Background and Clinical Significance: In stillbirth, bereaved parents must be promptly taken in by healthcare staff, and their requests to understand what happened must be fully explained and discussed. Empathic and open communication with the parents is fundamental in avoiding time-consuming lawsuits for investigating medical liability. Herein, we describe a case of stillbirth in which many elements exemplify potential concerns, either from a parental or judicial context. All these hypothetical questions will be addressed and discussed. Case presentation: A female stillbirth was vaginally delivered at 41 weeks of gestation after induction of labor. The baby was normally grown for gestational age, and the umbilical cord examination disclosed a length of 90 cm (75 cm attached to the placenta and 15 cm to the fetus), two tight knots, and a furcate insertion into the chorionic plate. Histologically, non-occlusive luminal thrombosis was found in the umbilical vein, extended to the cord insertion, and was in a few chorionic vessels. The knots showed myonecrosis in the vascular wall, widespread in the first one and more focal in the second, indicating prolonged contraction.

Conclusions: The case we described, though fully diagnostically explained, raised many hypothetical questions that might have been brought up either in a judicial context or during communication with the parents of the autopsy results. Frequent questions may include what the cause of death was, when the baby died, if the death might have been avoidable, and, in the latter, potential medical liability.