Results

I got a copy of the autopsy report in the mail on Saturday.  I had to share it with some nurse friends to make heads or tails of it-- just a lot of terminology that I didn't understand.  Here's the portions I shared with them, with my questions interspersed:

"A few of the chorionic plate vessels, which are fetal vessels, show nonocclusive to partially occlusive fibrin thrombi. Recommend considering evaluating the parents for a hypercoagulative state." Translate that first sentence? I've been tested and cleared of clotting issues-- the doctor said this would be something genetic from the parents that the baby inherited-- does that make sense? Also says the cord was "focally hypertwisted" (does hyper necessarily mean too much?) and "There is an area of narrowing in the cord which spans 2.8 cm in length and measures .6 cm in diameter. ... Cross sections through this area show only one vascular structure. No true knots, false knots are seen" (problem?). "The decidua basalis shows a very prominent chronic inflamation" (related to the subchorionic hematoma - SCH- I had?). "The fetal membranes shows rare pigment laden microphages, the significance of which is unclear" (just throwing that out in case it means anything).

What jumped out to them are the cord issues.  With a little more research, I've come to believe that cord torsion (hypertwisting) and cord stricture (narrowing) caused the death.  The clots (partially occlusive fibrin thrombi) can be a result of decreased blood flow, which would come from the problems with the cord.  One vascular structure is a major problem, since there should be three-- two arteries plus one vein.  5% of the time, there is only one artery, but to have only one vein or artery is necessarily fatal-- it wouldn't allow for blood to move to and from the baby.  My guess is that the torsion caused the other two vascular structures to collapse, which caused the death.

 

There are some theories that cord issues like these are genetic, but that's likely not something we could test for.  One of my friends who is well-versed in genetic issues also had this to say:

 

"With so many findings, I'm guessing baby had a syndrome of some sort. The occlusions don't strike me as the only cause of death, as they're referred to as "nonocclusive to partially occlusive"... meaning the fibrin thrombi are present but not large enough to actually occlude blood flow (although certainly partially occlusive thrombi could be enough to cause IUGR and ultimately death if present in enough quantities, but it doesn't sound like that to me based on the wording). The single vessel cord also points to syndrome. They may not be able to diagnose this with just a general chromosomal analysis, since many of the congenital syndromes are at the gene level and not the chromosome level. (One source I read even mentioned Zellweger syndrome, which is a form of leukodystrophy)."

 

The report did say the chromosomal analysis is still pending, so it's possible we'll get more information with those results, though I doubt it.  When we do get those results, though, I'll make an appointment with Dr. Berry to talk through it all and get his opinion about what we should do next or differently.