Cord Vessels Research Articles

Novel micro-ultrasound probe to identify microvessels in the spermatic cord

Previous studies have shown the benefit of real-time intra-operative audio Doppler identification of testicular arteries during microscopic subinguinal varicocelectomy. This minimizes the risk of inadvertent testicular artery injury. This study evaluates the use of a novel micro-ultrasound probe for thelocalization of arteries during such procedures. Prospectively maintained database cohort study. A new micro-ultrasound probe (Aloka-Hitachi Ltd., Tokyo, Japan) was utilized to localize the testicular arteries real-time during three robotic assisted sub-inguinal microsurgical varicocelectomy cases. The ultrasound image was fed into the TilePro (Intuitive Surgical, Sunnyvale, CA) surgeon console platform to provide three simultaneous real-time video images to the microsurgeon during the procedure: 1) a 12-15x 3D image via the HD robotic camera, 2) a 16-18x optical high magnification view via the VITOM camera (Karl Storz Inc., Tuttlingen, Germany) and 3) a real time visual ultrasound image from the new micro-ultrasound probe.Localization of the testicular arteries was validated against the current standard - audio Doppler mapping using a micro Doppler probe (Vascular Technology Inc., Nashua, NH). In all cases, the new ultrasound probe was able to identify all arteries in the spermatic cord (testicular artery & deferential artery). The probe also allowed visualization of small posterior varicose veins (1-2 mm diameter) that are sometimes easy to miss on visual examination. No arteries where missed by the micro-ultrasound probe based on the additional Doppler scanning. Accurate localization of the arteries in the spermatic cord vessel is critical to minimize inadvertent injury during microsurgical varicocelectomy. The new micro-ultrasound probe appears to be effective in micro-vessel localization in this preliminary study.

Overestimation of Umbilical Cord Coiling Index with Segmental versus Total Length Assessment

The umbilical cord is the only communication between the fetus and the placenta and, not surprisingly, lesions or conditions affecting it may have detrimental effects in both. One important feature of the umbilical cord is its coiling index (UCI), with hypo- and hypercoiling being associated with fetal thrombotic vasculopathy, intolerance of labor, intrauterine growth restriction, cord stricture, thrombosis of cord and chorionic blood vessels, and fetal demise. It is essential that every placenta report include the UCI. The UCI could also be assessed prenatally, but there is currently no way of accurately assessing the entire length of the umbilical cord. The aim of this study was to compare UCI measured in a segment of cord 10 cm long (UCI-10) and over its total length (UCI-T). One hundred fifty consecutive placenta reports in which both measurements were recorded were retrieved from the files and analyzed. Gestational age ranged from 16 to 42 weeks, with a mean of 33.67 ± 5.96 weeks and a median of 36 weeks. Mean UCI-10 was 0.4360 ± 0.2625 coils/cm and mean UCI-T was 0.3530 ± 0.2022 coils/cm; the difference between these measurements was highly statistically significant (P < 0.0001). Counting the number of umbilical cord coils in 10 cm led to an overestimation of the UCI-T by 23.5%; it can be concluded, therefore, that the latter should be used.

Experimental Syringohydromyelia Induced by Adhesive Arachnoiditis in the Rabbit: Changes in the Blood–Spinal Cord Barrier, Neuroinflammatory Foci, and Syrinx Formation

There are many histological examinations of syringohydromyelia in the literature. However, there has been very little experimental work on blood permeability in the spinal cord vessels and ultrastructural changes. We prepared an animal model of spinal adhesive arachnoiditis by injecting kaolin into the subarachnoid space at the eighth thoracic vertebra of rabbits. The animals were evaluated 4 months later. Of the 30 rabbits given kaolin injection into the cerebrospinal fluid, 23 showed complete circumferential obstruction. In the 7 animals with partial obstruction of the subarachnoid space, intramedullary changes were not observed. However, among the 23 animals showing complete obstruction of the subarachnoid space, dilatation of the central canal (hydromyelia) occurred in 21, and intramedullary syrinx (syringomyelia) was observed in 11. In animals with complete obstruction, fluorescence microscopy revealed intramedullary edema around the central canal, extending to the posterior columns. Electron microscopy of hydromyelia revealed a marked reduction of villi on the ependymal cells, separation of the ependymal cells, and cavitation of the subependymal layer. The dilated perivascular spaces indicate alterations of fluid exchange between the subarachnoid and extracellular spaces. Syringomyelia revealed that nerve fibers and nerve cells were exposed on the surface of the syrinx, and necrotic tissue was removed by macrophages to leave a syrinx. Both pathologies differ in their mechanism of development: hydromyelia is attributed to disturbed reflux of cerebrospinal fluid, while tissue necrosis due to disturbed intramedullary blood flow is considered to be involved in formation of the syrinx in syringomyelia.

Is it necessary to place a surgical clamp early in the spermatic cord during testicular examination via inguinal approach?

ObjectiveThe presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination. Materials and methodsInguinal testis studies were performed over a two-year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients. ResultsTesticular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range: 21–82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study. ConclusionIn our causistics, it seems that the surgical act consisting of the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients who will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.

When identical twins are different

BackgroundClassically monozygotic (MZ) twins are considered identical. However, there are a number of cases of MZ twins concordant for genotype but not phenotype. A review of these cases was performed...

Inhibitory effect of non-anticoagulant heparin (S-NACH) on pancreatic cancer cell adhesion and metastasis in human umbilical cord vessel segment and in mouse model

Metastasis is the most devastating aspect of cancer and it is the main cause of morbidity and mortality in cancer patients. Tumor cell adhesion to the vascular endothelial cell lining is an important step in metastatic progression and is prompted by platelets. Mucin 1 is over-expressed and aberrantly glycosylated in more than 60% of pancreatic ductal adeno-carcinomas, which mediate adhesion of pancreatic cancer cells to platelets via P-selectin. The anticoagulant low molecular weight heparins (LMWHs), which are commonly used in venous Thromboprophylaxis and treatment, appear to have an effect on cancer survival. The aim of this study is to investigate the effect of platelets on human pancreatic cancer MPanc96 cell adhesion to the endothelial cell vessel wall, and to examine the effect of heparin derivatives on MPanc96 adhesion using a novel, in vitro model of human umbilical cord vein. The modified heparin S-NACH (sulfated non-anticoagulant heparin), which is devoid of antithrombin (AT) binding and devoid of inhibition of systemic AT-dependent coagulation factors such as factor Xa and IIa, and the LMWH tinzaparin both potently reduced adhesion and invasion of fluorescence-labeled MPanc96 cancer cells to the endothelial layer of umbilical cord vein in a dose-dependent manner. S-NACH effectively inhibited P-selectin mediated MPanc96 cell adhesion, and inhibited cell adhesion and invasion similar to tinzaparin, indicating that systemic anticoagulation is not a necessary component for heparin attenuation of cancer cell adhesion, invasion, and metastasis. Also, S-NACH and tinzaparin versus unfractionated heparin, heparin derivatives enoxaparin, deltaparin, fraxiparin, and fondaparinux were evaluated for their effect on platelet-cancer cell adhesion. An in vivo anti-metastatic S-NACH-treated nude mouse model of MPanc96 pancreatic cancer cell metastasis demonstrated potent anti-metastasis efficacy as evidenced by IVIS imaging and histological staining.

Single Umbilical Artery and Pregnancy Outcome: Cause for Concern

ABSTRACT Objective To study the pregnancy outcome of antenatal women diagnosed with single umbilical artery (SUA) in singleton pregnancy in tertiary medical center and its association with intrauterine growth restriction (IUGR), renal and cardiac anomalies. Materials and methods We performed a prospective study of 6,711 singleton pregnancies at Sri Ramachandra Medical College, Chennai, between July 2009 and June 2011 and the pregnancies diagnosed with SUA were followed. The primary outcomes were renal anomalies, cardiac anomalies and IUGR. Results Of the 6,711 pregnancies there were 59 (0.88%) cases of SUA diagnosed at anatomic survey. Thirty seven pregnancies had isolated SUA (62.7%) and 22 singleton pregnancies had associated malformations (37.2%). Conclusion Our data suggests that the prevalence of SUA and associated anomalies seems to be similar to that reported in other countries. Evaluating cord vessels is important and fetuses with isolated SUA need more detailed assessment and monitoring1 including Doppler study in the presence of IUGR. SUA with multiple anomalies need further evalution with fetal echocardiogram and invasive tests like amniocentesis for karyotyping. How to cite this article Vasanthalakshmi GN, Pushpalatha, Mehta P, Devi SA. Single Umbilical Artery and Pregnancy Outcome: Cause for Concern. J South Asian Feder Obst Gynae 2012;4(2):103-105.

Is intraoperative ultrasound required in cervical spinal tumors ? a prospective study

To determine the role of intraoperative ultrasonography (IOUSG) in the surgical management of patients with intradural spinal tumors. Twenty-six patients with intradural spinal cord tumors were surgically treated under intraoperative ultrasonographic guidance between January 2007 and May 2011. Guidance with IOUSG was used in 26 patients, of which 14 fourteen had extramedullary and 12 had intramedullary tumors. Intraoperative ultrasound assistance was used to localize each tumor exactly before opening the dura. The extent of tumor resection was verified using axial and sagittal sonographic views. The extent of tumor resection achieved with IOUSG guidance was assessed on postoperative early control MRI sections. Total tumor resection was achieved in 22 (84%) of 26 cases. All of the residual tumors were typically intramedullary and infiltrative. The sensitivity of IOUSG for the determination of the extent of resection was found to be 92%. Ultrasonography was found to be effective in identification of tumor boundaries and protection of spinal cord vessels. The average time spent for IOUSG assessment was 7 minutes. Intraoperative ultrasonography is practical, reliable and highly sensitive for spinal cord surgery. It not only enhances surgical orientation, but also reduces morbidity and helps to resect the tumor completely.

Lessons learnt from umbilical cord accidents: are these stillbirths preventable?

Umbilical cord accidents (UCA) refer to a group of conditions, where the umbilical cord vessels undergo sudden compression, compromising the blood flow to the fetus. UCA are associated with still birth and are often considered to be an etiology of sudden antenatal death syndrome. Herein, we report three cases of UCA, which reported late to us, resulting in fetal demise.

Cell Therapy for the Treatment of Metabolic Liver Disease: An Update on the Umbilical Cord Derived Stem Cells Candidates

Cell therapy has emerged as an attractive alternative to orthotopic liver transplantation for the treatment of liver disease. Among the potential candidates, umbilical cord derived stem cells are of particular interest owing to greater proliferation potential and low immunoreactivity. Previous reports permit to distinguish different cell types that could be generated from cord blood, vessels and cord matrix itself. Wharton Jelly's derived umbilical cord stem cells and cord- blood derived mesenchymal stem cells have demonstrated a potential to differentiate into endodermal lineage, including hepatocyte-like cells. In addition, recent studies have underlined their potential to alleviate liver fibrosis and express liver metabolic functions in rodent models. The present review focuses on the current knowledge on in vitro and in vivo use of these cells for liver cell therapy. We discuss the general characteristics homology between hepatic and umbilical cord derived stem cells and the results of hepatocyte-like differentiation attempts. We finally address the question of future application of these cells for the treatment of liver disease.

766: Dysfunctional vascular adaptations in human umbilical vein endothelial cells (HUVEC) in preeclamptic pregnancies

Preeclampsia (PE) occurs in 4-8% of all pregnancies. Endothelial cell dysfunction due to PE seen on the maternal side is also found in the umbilical vein. Our previous studies on umbilical vein endothelium (UV endo) of fresh cord vessels showed the sustained nitric oxide production and initial and sustained Ca2+ burst responses of normal pregnancy are impaired in PE. The basis of this dysfunction is unclear. Our hypothesis is these losses in Ca2+ response may either be due to failed programming of cell function or active suppression of such programming by local factors or inflammatory mediators.

¿Resulta necesaria la colocación de una pinza quirúrgica tempranamente en el cordón espermático durante la exploración testicular por vía inguinal?

ObjectiveThe presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination. Material and methodsInguinal testis studies were performed over a two year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients. ResultsTesticular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range 21-82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study. ConclusionIn our causistics, it seems that the surgical act consisting in the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients that will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.

Genome-wide analysis of gene expression during Xenopus tropicalis tadpole tail regeneration

BackgroundThe molecular mechanisms governing vertebrate appendage regeneration remain poorly understood. Uncovering these mechanisms may lead to novel therapies aimed at alleviating human disfigurement and visible loss of function following injury. Here, we explore tadpole tail regeneration in Xenopus tropicalis, a diploid frog with a sequenced genome.ResultsWe found that, like the traditionally used Xenopus laevis, the Xenopus tropicalis tadpole has the capacity to regenerate its tail following amputation, including its spinal cord, muscle, and major blood vessels. We examined gene expression using the Xenopus tropicalis Affymetrix genome array during three phases of regeneration, uncovering more than 1,000 genes that are significantly modulated during tail regeneration. Target validation, using RT-qPCR followed by gene ontology (GO) analysis, revealed a dynamic regulation of genes involved in the inflammatory response, intracellular metabolism, and energy regulation. Meta-analyses of the array data and validation by RT-qPCR and in situ hybridization uncovered a subset of genes upregulated during the early and intermediate phases of regeneration that are involved in the generation of NADP/H, suggesting that these pathways may be important for proper tail regeneration.ConclusionsThe Xenopus tropicalis tadpole is a powerful model to elucidate the genetic mechanisms of vertebrate appendage regeneration. We have produced a novel and substantial microarray data set examining gene expression during vertebrate appendage regeneration.

Caesarian Delivery Impair Innate Immunity of Mother and Newborn

Introduction: An increased risk of infectious and allergic disease has been suggested for neonates born from caesarean delivery. The innate immunity play a crucial role in the host defence in neonatal age. The aim of this study is to evaluate the effects of delivery mode on innate immunity in newborn. Methods: Prospective, multicentre study involving newborns with birth weight (BW) > 2000 g and gestational age (GA) > 37 weeks. Serum levels of alpha- (HNP 1-3) and beta-defensins (hBD-2) were adopted as a markers of innate immune response. At birth, blood samples from neonatal cord vessels and from their mother peripheral vein were collected, and HPN 1-3 and hBD-2 were measured by commercially available ELISA kits. Data regarding pregnancy and perinatal period were also recorded. Results: Data from 66 newborns and their mother's were available. Levels of hBD2 were higher in newborn by spontaneous delivery (122.7 ± 4.6 pg/ml) than in those born by caesarian section (107.5 ± 5.5 pg/ml, p= 0.038). In the absence of labor maternal HNP 1-3 resulted significantly lower (245.3 ± 25.7 ng/ml) than in the presence of labor (594.6 ± 36.3 ng/ml, p=0.007). Conclusions: Caesarian delivery and absence of labor impair innate immunity in newborns. This may have important implications in the prevention of infectious and allergic disease early in the life.

NeonatOx: A Pumpless Extracorporeal Lung Support for Premature Neonates

Gas exchange in premature neonates is regularly impaired by structural and functional immaturity of the lung. Mechanical ventilation, which is vitally important to sustain oxygenation and CO(2) elimination, causes, at the same time, mechanical and inflammatory destruction of lung tissue. To date, extracorporeal oxygenation is not a treatment option, one reason among others being the size of available oxygenators and cannulas. We hypothesized that a substantial improvement in gas exchange can be achieved by maintenance of the fetal cardiopulmonary bypass and interposition of a suitable passively driven (arteriovenous) membrane oxygenator. In close cooperation between engineers and neonatologists, we developed a miniaturized oxygenator and adapted cannulas to be used as a pumpless extracorporeal lung support that is connected to the circulation via cannulation of the umbilical cord vessels. First in vitro and in vivo studies show promising results. We regard this as one step on the way to clinical application of the artificial placenta.

Human type 2 17beta-hydroxysteroid dehydrogenase in umbilical vein and artery endothelial cells: differential inactivation of sex steroids according to the vessel type

The human placenta produces high amounts of estradiol. 17β-hydroxysteroid dehydrogenase type 2 (17βHSD2) is expressed by placental endothelial cells and was proposed to regulate sex hormone levels. Previous results obtained in term placenta suggested that 17βHSD2 expression and activity differ among umbilical cord vessels. In this study, 17βHSD2 expression level and enzymatic activity, and estrogen receptor α and β expression levels, were measured in endothelial cell cultures from umbilical arteries (HUAEC) and vein (HUVEC) using real-time quantitative PCR, western blot, and radiolabeled steroids. 17βHSD2-specific activities were also measured in proximal and distal segments of freshly isolated umbilical cord arteries and vein. 17βHSD2 mRNA level and activity were higher in HUAEC than in HUVEC. Activity was higher in umbilical arteries than in the umbilical vein. In arteries, enzymatic activity was higher near the placenta, suggesting a gradient of expression. No difference was found in ERα expression, whereas ERβ was expressed at a higher level in HUAEC than in HUVEC. Expression profiles of estrogen receptors and 17βHSD2 suggest a vessel type-specific response to estrogens. Our data support a differential modulation of biologically active sex steroid levels according to the vessel type in the foeto-placental unit, with apparent higher inactivation in the arterial system.

Surgical management of recurrent thoracolumbar spinal sarcoma with 4-level total en bloc spondylectomy: description of technique and report of two cases

The descriptions of total spondylectomy and further development of the technique for the treatment of vertebral sarcomas offered for the first time the opportunity to achieve oncologically sufficient resection margins, thereby improving local tumor control and overall survival. Today, single level en bloc spondylectomies are routinely performed and discussed in the literature while only few data are available for multi-level resections. However, due to the topographic vicinity of the spinal cord and large vessels, the multisegmental resections are technically demanding, represent major surgery and only few case reports are available. Surgical options are even more limited in cases of revision surgery and local recurrences when en bloc spondylectomy was considered to be not feasible due to high risk of vital complications in expanding resection margins. Deranged anatomy, implants in situ and extensive intra-/paraspinal scar tissue formation resulting from previously performed approaches and/or radiation are considered the principal complicating factors that usually hold back spine surgeons to perform revision for resection leaving the patient to palliative treatment. We present two patient cases with previously performed piecemeal vertebrectomy in the thoracic spine due to a solitary high-grade spinal sarcoma. After extensive re-staging, both patients underwent a multi (4)-level en bloc spondylectomy in our department (one patient with combined en bloc lung resection). Except a local wound disturbance, there was no severe intra- or postoperative complication. After multilevel en bloc spondylectomy both patients showed a good functional outcome without neurological deficits, except those resulting from oncologically scheduled resection of thoracic nerve roots. After a median follow-up of 13months, there was no local recurrence or distant metastasis. The reconstruction using a posterior screw rod system that is interconnected to an anterior vertebral body replacement with a carbon composite cage showed no implant failure or loosening. In summary, the approach of a multilevel en bloc surgery for revision and oncologically sufficient resection in cases of spinal sarcoma recurrences seems possible. However, interdisciplinary decision making in a tumor board, realistic evaluation of surgical resectability to attain tumor free margins, advanced experiences in spinal reconstructions and involvement of vascular, visceral and thoracic surgical expertise are essential preconditions for acceptable oncological and functional outcome.

Morfologia do funículo espermático em caprinos da raça Bhuj Brasileira

Estudamos em 40 caprinos adultos da raça Bhuj Brasileira os aspectos histológicos do funículo espermático. Observamos que este se acha envolvido por uma cápsula de tecido conjuntivo fibroelástico denso, de espessura variável, pregueada em alguns pontos, e revestida por mesotélio que circunda todo o conjunto vásculo-nervoso, e projeta-se para formar o mesoducto deferente. Em posição subcapsular, verifica-se uma camada de tecido conjuntivo fibroelástico frouxo, de espessura variável, que circunda parcialmente o funículo espermático, isolando nas regiões deferencial e abdeferencial, conjuntos vásculo-nervosos, responsáveis pela nutrição do epidídimo. Na região do mesoducto deferente, o tecido subcapsular acompanhado de tecido adiposo constitui a camada interna deste meso, formando a sua adventícia e abrigando vasos e nervos deferenciais. Na região abdeferencial, pequenos acúmulos de tecido adiposo são vistos de permeio aos vasos e nervos desta região. Entre as artérias, veias e nervos testiculares, bem como entre os vasos das regiões deferencial e abdeferencial, observa-se o tecido conjuntivo denso, intervascular, rico em fibras elásticas, que constitui as adventícias contínuas destes vasos. O arranjo vascular mostra que o segmento da artéria testicular, contido no funículo espermático, apresenta trajeto sinuoso. Estando envolvido pelo plexo venoso pampiniforme, formado por veias testiculares desprovidas de válvulas de calibres variados, apresentando amplas comunicações entre si. As veias responsáveis pela drenagem do epidídimo e ducto deferente estão localizadas em posição subcapsular deferencial e abdeferencial e mostram-se providas de válvulas. O trato das artérias testiculares no funículo espermático apresenta como média e desvio padrão 134,6±38,1cm à direita, e 137,0±33,9cm à esquerda, não existindo diferenças estatisticamente significantes ao nível de 5%, quando comparamos a média do segmento da artéria testicular contida no funículo espermático direito em relação ao esquerdo.

Vascular Endothelial Expression of Indoleamine 2,3-Dioxygenase 1 Forms a Positive Gradient towards the Feto-Maternal Interface

We describe the distribution of indoleamine 2,3-dioxygenase 1 (IDO1) in vascular endothelium of human first-trimester and term placenta. Expression of IDO1 protein on the fetal side of the interface extended from almost exclusively sub-trophoblastic capillaries in first-trimester placenta to a nearly general presence on villous vascular endothelia at term, including also most bigger vessels such as villous arteries and veins of stem villi and vessels of the chorionic plate. Umbilical cord vessels were generally negative for IDO1 protein. In the fetal part of the placenta positivity for IDO1 was restricted to vascular endothelium, which did not co-express HLA-DR. This finding paralleled detectability of IDO1 mRNA in first trimester and term tissue and a high increase in the kynurenine to tryptophan ratio in chorionic villous tissue from first trimester to term placenta. Endothelial cells isolated from the chorionic plate of term placenta expressed IDO1 mRNA in contrast to endothelial cells originating from human umbilical vein, iliac vein or aorta. In first trimester decidua we found endothelium of arteries rather than veins expressing IDO1, which was complementory to expression of HLA-DR. An estimation of IDO activity on the basis of the ratio of kynurenine and tryptophan in blood taken from vessels of the chorionic plate of term placenta indicated far higher values than those found in the peripheral blood of adults. Thus, a gradient of vascular endothelial IDO1 expression is present at both sides of the feto-maternal interface.

Hämorrhagischer Schock eines Neugeborenen aufgrund Nabelschnurruptur während Unterwassergeburt

We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss. A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally. Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential. Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.