Clinical History: This 23 week gestation infant was transferred because of prolapse of the umbilical cord with a breech lie. The external fetal heart rate monitor showed only an intermittent fetal tracing. Labor was induced with Pitocin. The fetal heart rate tracing was lost 2 hours prior to delivery.
Autopsy findings: A portion of the umbilical cord was attached to the fetus. The portion of the cord nearest the fetus appeared pale compared to the more distal, congested portion of cord. The thorax demonstrated effusions, but no petechiae.
Discussion: This case does not demonstrate pathological evidence of gasping but rather that of acute heart failure with pleural and pericardial effusions. These findings are typical of progressive hypoxia, acidosis, and heart failure, which in this case was likely from incomplete or intermittent cord compression. The red discoloration of the cord after only 2 hours of postmortem retention is not expected. Possibly the arterial blood was reaching the placenta, but the blockage of venous return led to venous stasis and diffusion of hemoglobin from the umbilical vein prior to fetal death.
Fig 1: There is a relatively sharp demarcation between the white portion and the reddened portion of the umbilical cord.
Fig 2: The arrow points to the pericardial effusion.
obstetrical pathology 