Severe hemorrhage from the umbilical cord at birth: a preventable cause of neonatal shock.

Neetu Singh,Gautham Suresh

doi:10.1155/2013/317627

Abstract

Posthemorrhagic anemia is a rare but important cause of anemia in neonates, second only to hemolytic anemia of newborn. Most cases of posthemorrhagic anemia are reported from fetomaternal hemorrhage or umbilical cord accidents in utero. This case report describes a preterm infant who developed severe anemia and shock immediately after delivery related to an acute hemorrhage through patent umbilical cord vessels secondary to a tear in the umbilical cord at the site of cord clamping. We believe that umbilical cord bleeding from errors in cord clamping could be an important cause of acute blood loss in the delivery room and that it may result in significant clinical morbidity, especially in extremely premature infants.

Highlights

Posthemorrhagic anemia in the newborn can result from antenatal, intrapartum, or postnatal causes
Preterm infants are in a fragile condition at birth, and hemorrhagic anemia and shock due to blood loss at birth can further adversely impact their hospital course and final outcome
The significant blood loss at birth from a tear in the umbilical cord led to shock and severe metabolic acidosis, necessitating emergency blood transfusion in the delivery room in addition to standard resuscitation measures. Such umbilical cord hemorrhage can occur if the umbilical cord clamp placed prior to cutting of the cord becomes loosened or does not occlude one or more of the umbilical vessels

Summary

Introduction

Posthemorrhagic anemia in the newborn can result from antenatal, intrapartum, or postnatal causes. There is a paucity of literature on causes of neonatal blood loss during or immediately after delivery, those related to bleeding from the umbilical cord at the time of birth. This preventable cause of acute postnatal blood loss has not been emphasized in the literature before and may be more common than previously recognized

Case Presentation

Discussion

Findings

Conflict of Interests