Umbilical Cord Hematoma Research Articles

Spontaneous Umbilical Cord Vascular Rupture during Labor: A Retrospective Analysis of 12 Cases.

Umbilical cord vascular rupture is a rare and severe condition that can occur during labor, leading to adverse outcomes for the fetus before as well as after delivery. Prompt diagnosis and intervention are crucial for improving the chances of a successful outcome. We aimed to analyze cases of umbilical cord vascular rupture during labor to provide insights into this challenging condition. This retrospective study evaluated the medical records of patients diagnosed with umbilical cord vessel rupture or umbilical cord hematoma at Fujian Maternity and Child Health Hospital from January 1, 2015, to May 31, 2023. The inclusion criteria included gestational age of ≥28 weeks, occurrence during labor, and availability of complete delivery data. Data on fetal heart rate (FHR) changes, delivery intervals, intraoperative findings, placental pathology, and neonatal outcomes were collected and analyzed. A total of 12 cases were analyzed. The incidence of umbilical cord vascular rupture during childbirth was 0.08%. The FHR patterns in umbilical cord rupture during delivery included baseline tachycardia, minimal or absent variability, variable or late deceleration, prolonged deceleration, and undetectable heart rate. The bradycardia-to-delivery interval (BDI) ranged from 6 to 26 minutes. Among the 12 neonates, 9 were discharged well, 2 were stillbirths, and there was 1 neonatal death. Hemorrhagic shock was common in live births. Our study highlights the significance of continuous FHR monitoring during labor and the urgent need for medical teams to respond quickly in cases of umbilical cord vascular rupture. Despite advancements in neonatal resuscitation techniques, managing cases with undetectable fetal heart activity remains clinically challenging, and even with immediate pregnancy termination, poor neonatal outcomes may still occur. · Umbilical cord vascular rupture during labor is a rare event.. · Its clinical management presents significant challenges.. · Advances in neonatal resuscitation have improved rescue success rates.. · In such cases, hemorrhagic shock is common in live births..

ИНТРААБДОМИНАЛЬНАЯ АНЕВРИЗМА ПУПОЧНОЙ ВЕНЫ ПЛОДА. (РЕДКИЙ КЛИНИЧЕСКИЙ СЛУЧАЙ)

The umbilical cord is an extension of the fetal cardiovascular system. According to all available scientific data, umbilical cord abnormalities play an important and often decisive role in the development of complications during pregnancy and childbirth, including perinatal mortality. Thus, umbilical cord abnormalities include skinny umbilical cord, umbilical cord presentation, absolutely short umbilical cord, sheath attachment of the umbilical cord, presentation of umbilical cord vessels, hypoisvite and hyperisvite umbilical cord, single umbilical artery, persistence of the right umbilical vein, vein aneurysm and umbilical cord hematoma. There are several variants of localization of this vascular anomaly: in the area of attachment to the placenta, in the free part, in the area of the umbilical ring and in the intraabdominal (intrahepatic) part. There are no clinical recommendations for the management of pregnancy with an umbilical vein aneurysm. When detecting umbilical cord abnormalities, it is necessary to monitor the dynamics of changes in the size of the aneurysm with an assessment of the fetal condition. The article describes a clinical case of intraabdominal fetal umbilical vein aneurysm, which is extremely rare and accounts for less than 1% of all umbilical cord abnormalities. The patient's reproductive and genetic history is not burdened. The somatic history was aggravated by neurodegenerative diseases of the spine. The pregnancy proceeded against the background of repeated threats of termination of pregnancy and anemia.

Umbilical cord hematoma – a successful case of a non-frequent acute fetal distress etiology

Background: Umbilical cord hematoma is a rare condition, with mortality rates up to 50%. Most of the literature describes cases with poor prognosis. Case description: In this case, a healthy pregnant woman in labor presented some variable decelerations on the fetal heart rate monitoring ending in sustained bradycardia. An emergency C-section was performed, giving birth to a 40-weeks male newborn with an umbilical cord hematoma until placental insertion and, slightly stump bleeding. Newborn got pale and, had respiratory distress in the first hour of life. He presented transient metabolic acidosis with hyperlacticaemia and, anemia. There was a favorable evolution with supportive therapy. No risk factor was identified and, histological examination confirmed the diagnosis. The patient remained asymptomatic and, presented normal neurodevelopment during follow-up. Discussion: This case report aims to demonstrate a good outcome when a high level of suspicion is taken and immediate medical and, surgical interventions are performed

Down syndrome with umbilical cord hematoma: Case report and review of literature

Umbilical cord hematoma (UCH) is the extravasation of blood in the umbilical cord. The condition is rare and asymptomatic but very important to recognize because it can potentially compromise fetal blood flow. Hence, UCH increases the chances of fetal mortality and morbidity. We are presenting the case report of a large but asymptomatic UCH in a newborn baby with Down syndrome. To the best of our knowledge, the association between Down syndrome and UCH has not been reported in medical literature till the time of writing of this manuscript.

Umbilical Cord Haematoma and Uterine Torsion: Rare Pregnancy Complications at Tu Du Hospital in Vietnam and a Review of Literature

Umbilical cord haematoma (UCH) and uterine torsion are extremely rare complications in pregnancy. These abnormalities may present in acute and spontaneous conditions, however, they should not be neglected in clinical practice when monitoring an abnormal fetal heart without other suspects. The authors hereby report a rare case of UCH and uterine torsion as well as a review of the literature. A female, aged 35 years old (gravida 1, para 0), was admitted to the Emergency Department of Tu Du Hospital, Ho Chi Minh City, Vietnam, due to term gestation without complaints. They had an uncomplicated pregnancy, except a large uterine fibroid and cervical pessary which prevented pre-term birth from 28 weeks of gestational age. A very rare complication of UCH was revealed accidentally following emergency caesarean section associated with abnormal fetal heart rate tracing. Asymptomatic uterine torsion was noticed at the same time as this dramatic event. Pre-operative diagnosis of two rare complications was missed; hence, the authors timely delivered the baby based on another modality of management, computerised cardiotocography. In conclusion, UCH along with uterine torsion is difficult to diagnosis due to its rarity; it is usually an incidental finding. Moreover, no available imaging modality could investigate UCH prior to delivery. Surveillance on fetal heart rate monitoring may be helpful in this fatal situation.

Umbilical cord haematoma in a preterm newborn.

Umbilical cord haematoma (UCH) is a spontaneous bleeding in the umbilical cord caused by the rupture of umbilical vessels with blood extravasation in the Warton’s jelly. This condition is a rare complication of pregnancy (1:5000-11000 deliveries). UCH may cause fetal distress and it can be associated with stillbirth (50% of cases). For these reasons, close surveillance is required when diagnosed by antenatal ultrasound.( – ) Various risk factors have been suggested such as cord anomalies, infection, coagulation disorder, post maturity, [...]

A case of fetal distress associated with an umbilical cord hematoma

A case of fetal distress associated with an umbilical cord hematoma

Spontaneous Umbilical Cord Hematoma

Spontaneous umbilical cord hematoma is a rare complication with a usually benign course but is potentially fatal without vigilant and timely medical intervention.We present the case of a 23-year-old primigravida mother who presented in labor. She was placed on continuous fetal heart rate monitoring, which showed two episodes of fetal heart rate tracing of the category II variety. The labor was induced with oxytocin, and the ammonitic membrane was incised artificially. The baby was male, term at 38 weeks, with an appropriate weight, length, and head circumference. There was no gross anomaly or dysmorphic features; the APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score of the baby was 9 and 9 at the first and fifth minutes, respectively. A 4.5 cm hematoma was discovered on the umbilical cord immediately following delivery. He was admitted to the regular nursery for routine newborn care and was discharged home in stable condition. Spontaneous umbilical cord hematoma is usually due to the rupture of the umbilical vein. Mostly, the umbilical cord hematoma occurs spontaneously and often follows a benign course, however, in some cases, the perinatal loss secondary to umbilical cord hematoma could very high, especially if associated with abnormal fetal heart rate tracing. Because of the potential for fatality inherent in this condition and to understand the clinical manifestations, risk factors, and eventual course of spontaneous cord hematoma, we present this case to help fellow pediatricians reduce morbidity and mortality associated with it.

Case 1: A Term Neonate with Conjunctival Hemorrhage, Ecchymoses, and Umbilical Hematoma

A term male neonate with a birthweight of 3,350 g is born via emergency cesarean delivery for the indication of abruptio placenta. The mother is a booked and immunized, gravida 4, para 3 woman with normal platelet counts and an uneventful antenatal course. The neonate was conceived spontaneously in a nonconsanguineous marriage and the family history is nonsignificant. The neonate has a normal transition after birth, is given a 1-mg intramuscular injection of vitamin K in the right thigh; he rooms in with the mother and is exclusively breastfed. Around 48 hours after birth, the neonate is noted to have bilateral conjunctival hemorrhages, ecchymoses on the face and trunk/back, boggy swelling over the scalp, and umbilical cord hematoma (Figs 1, 2 and 3). The neonate is noted to have pallor, but his vital sign parameters are normal (heart rate 140 beats/min, respiratory rate 40 breaths/min, temperature 98.6oF [37oC], capillary refill time <2 seconds, and oxygen saturation 96% in room air). There is no history of hematemesis, hematuria, or bleeding per rectum. Figure 1. Conjunctival hemorrhage. Figure 2. Ecchymoses on the face. Figure 3. Umbilical hematoma. ### Progression With a provisional clinical diagnosis of vitamin K deficiency bleeding (VKDB), the neonate is given a repeat 1-mg intramuscular injection of vitamin K and evaluated for the cause of the bleeding manifestations. Laboratory investigations reveal a hemoglobin of 6.4 …

Spontaneous umbilical cord hematoma with a favorable outcome

Umbilical cord hematoma is a rare but serious complication of pregnancy or childbirth that often results in neonatal hypoxia–ischemia and death. We describe a newborn infant with spontaneous umbilical cord hematoma, resulting in transient hypoxia–ischemia. Treatment with therapeutic hypothermia was rapidly initiated by a multidisciplinary team of obstetricians, midwives, and neonatologists. Risk factors for umbilical cord hematoma reported in the literature were investigated. The neurological signs, electroencephalogram, and blood analysis results improved rapidly. This case report demonstrates that the effective management of anoxia–ischemia caused by umbilical cord hematoma can lead to a positive outcome for the newborn infant.

Congenital hernia of umbilical cord masquerading as umbilical cyst and omphalocele on antenatal scans

Congenital hernia of the umbilical cord (CHUC) is a rare, distinctive anomaly with variable presentation and conflicting terminology. We report two newborn infants who had fetal antenatal diagnosis as umbilical cord cyst and omphalocele, respectively, and were subsequently found to have hernia into the umbilical cord. The herniating mass in CHUC may vary greatly in size, making it difficult to differentiate with other conditions such as congenital umbilical cord cyst, cord hematoma, omphalocele, and gastroschisis. CHUC is prone to inadvertent cord clamping and injury to the gut. The failure of retraction of intestinal loops following physiological herniation has been postulated as the embryological basis of this entity. Overall prognosis is good.

Corrigendum to "Umbilical Cord Hematoma: A Case Report and Review of the Literature".

[This corrects the article DOI: 10.1155/2018/2610980.].

Umbilical Cord Hematoma: A Case Report and Review of the Literature.

Objectives To deepen the knowledge in obstetrics on a very rare pregnancy complication: umbilical cord hematoma. Methods A review of the case reports described in the last ten years in the literature was conducted in order to evaluate epidemiology, predisposing factors, potential outcomes, prenatal diagnosis, and clinical management. Results Spontaneous umbilical cord hematoma is a rare complication of pregnancy which represents a serious cause of fetal morbidity and mortality. There are many risk factors such as morphologic anomalies, infections, vessel wall abnormalities, iatrogenic causes, and traction or torsion of the cord, but the exact etiology is still unknown. Conclusions Due to the rarity of this condition, every new case of umbilical cord hematoma should be reported in order to improve the knowledge of predisposing factors, prenatal diagnosis, and clinical management.

Factor XIII deficiency in Iran: a comprehensive review of the literature.

Factor XIII deficiency (FXIIID) is a rare bleeding disorder with an estimated prevalence of 1 in 2-million population worldwide. In Iran, a Middle Eastern country with a high rate of consanguineous marriages, there are approximately 473 patients afflicted with FXIIID. An approximately 12-fold higher prevalence of FXIIID is estimated in Iran in comparison with overall worldwide frequency. In this study, we have undertaken a comprehensive review on different aspects of FXIIID in the Iranian population. The distribution of this disease in different regions of Iran reveals that Sistan and Baluchestan Province has not only the highest number of patients with FXIIID in Iran but the highest global incidence of this condition. Among Iranian patients, umbilical cord bleeding, hematoma, and prolonged wound bleeding are the most frequent clinical manifestations. There are several disease causing mutations in Iranian patients with FXIIID, with Trp187Arg being the most common mutation in FXIIID in Iran. Traditionally, the management of FXIIID in Iran was only based on administration of fresh frozen plasma or cryoprecipitate, until 2009 when FXIII concentrate became available for patient management. Various studies have evaluated the efficacy and safety of prophylactic regimens in different situations with valuable findings. Although the focus of this study is on Iran, it offers considerable insight into FXIIID, which can be applied more extensively to improve the management and quality of life in all affected patients.

Successful management of severe hemolytic disease of the fetus due to anti‐Jsb using intrauterine transfusions with serial maternal blood donations: a case report and a review of the literature

The management of pregnant women with anti-Jsb is challenging due to the paucity of antigen-negative blood for fetal and neonatal transfusion. A 29-year-old woman with anti-Jsb was referred for assessment of recurrent fetal losses. With the presence of the sister as a historically matched donor, she was planned for active surveillance for fetal anemia during pregnancy. The fetus remained well until 21 weeks of gestation when signs of fetal anemia and early hydrops fetalis were noted. Anti-Jsb titer was at 128. The sister's red blood cells (RBCs) were cross-match incompatible. Urgent intrauterine transfusion (IUT) was performed with washed irradiated maternal RBCs, donated after cessation of heparin. The mother was given intravenous iron (IV-Fe) and continued on weekly recombinant human erythropoietin (rHu-EPO). Repeated IUTs were needed every 1 to 3 weeks. Throughout a 7-week period, three maternal donations were performed with total donated whole blood volume of 1250 mL, supporting four IUTs. At 29 weeks of gestation, the procedure was complicated by umbilical cord hematoma necessitating urgent cesarean section. A male newborn was delivered, transfused at birth, and subsequently treated with phototherapy and five top-up transfusions. This case represents a successful example of managing hemolytic disease of the fetus due to a rare antibody using maternal blood. It also supports previous data on safety of maternal donations during pregnancy and the use of combination of rHu-EPO and IV-Fe as a supportive measure.

Encefalopatía hipóxico-isquémica tras hematoma espontáneo de cordón umbilical

ObjectiveTo present the case of a pregnant woman with a spontaneous umbilical cord hematoma and to provide a review of the literature. Subjects and methodsA primigravida, with no antecedents of interest and uneventful pregnancy, was admitted to our hospital in the latent phase of labor. Cardiotocography was unsatisfactory, and an urgent cesarean section was performed. ResultsA 3050g girl was born, with an Apgar score of 1/3, and was admitted to the intensive care unit. The neonate was discharged with a diagnosis of hypoxic-ischemic encephalopathy. ConclusionsUmbilical cord abnormalities should be suspected when the results of fetal monitoring are unsatisfactory. Histological analysis of the umbilical cord should be performed.

Spontaneous umbilical cord haematoma and congenital factor VII deficiency

Spontaneous umbilical cord haematoma and congenital factor VII deficiency

The fetal heart monitor tracing in pregnancies complicated by a spontaneous umbilical cord hematoma

The objective of this study is to present and describe the fetal heart rate appearance in pregnancies complicated by an antenatal spontaneous umbilical cord hematoma that resulted in a live birth. Three cases of antenatal spontaneous umbilical cord hematoma are described. All three patients presented with a complaint of decreased fetal movement. The fetal heart monitor tracings on admission are depicted and discussed. In all three cases, the fetal heart rate pattern showed decreased variability with an absence of accelerations. Decelerations were noted but were identified in 25% or less of the contractions and primarily with contractions that exceeded 90 s. Absent accelerations with minimal to absent variability, if caused by uteroplacental insufficiency, usually develop in the presence of recurrent decelerations. Absent accelerations with minimal to absent variability in the absence of recurrent decelerations may suggest other causes including aneuploidy or congenital cardiac or neurologic anomalies. Though rare, spontaneous umbilical cord hematoma can be added to the differential.

Spontaneous Umbilical Cord Hematoma

Spontaneous hematoma of the umbilical cord represents a rare cause of fetal morbidity and mortality and the outcome is poor in half of the cases. There are many risk factors, such as infections, morphologic anomalies, alterations of the vessel walls, prolapses, twisting and traction of the cord, but in many cases the causes remain unknown. We present 3 cases of umbilical cord hematoma which took place at the end of the pregnancy and were followed by perinatal death of the fetus. In the 3 cases, which were autopsied including macroscopical and histopathologic examination of the placenta and the umbilical cord, a cordonal pathology was present; in all cases, there were alterations of the vascular wall, and in the third case inflammatory vasculopathy was found. In all 3 cases, the cause of death was attributed to acute anoxia due to the cordonal hematoma.

Umbilical cord hematoma: association with chorioamnionitis and funisitis

Umbilical cord hematoma is a very rare and life-threatening complication of pregnancy and is mostly seen secondary to cordcentesis. Although recent reports showed that intrauterine infection is a risk factor for the subsequent development of cerebral palsy 1, association of chorioamnionitis (CAM) and funisitis with umbilical cord hematoma has not been mentioned. A 37-year-old woman, para 2, with an uncomplicated antenatal course, at 38 weeks of gestation, developed a fever at 6:00. On admission, body temperature was 39.8°C. Vaginal examination showed rupture of the membranes. Bacteriological examination of the vaginal fluor later revealed Staphylococcus aureus. Although variable decelerations reaching near 70 beats/min were demonstrated occasionally, we confirmed the fetal well-being by the observation of both accelerations and variability (Figure 1A). The fetus suddenly developed a severe bradycardia at 10:27 and an emergency cesarean section was decided. Intrauterine death was confirmed by ultrasonography on arrival in the operating room at 10:50. Thirty-five minutes later, a stillborn female infant weighing 3,240 g was delivered through vagina. Histological examination of the umbilical cord revealed hematoma dissecting muscle layers, destroying the structure of the vein, and surrounding one of the arteries. The lesion was located close to the area of the cord insertion into the placenta. Both funisitis (grade III) and CAM (grade III) were confirmed. Fetal heart rate tracing of case 1 (A) and case 2 (B) showed sudden and persisted bradycardia. A 37-year-old woman, para 0, with an uneventful antenatal course, at 41 weeks of gestation, was admitted to our hospital for delivery. After rupture of the membranes the next day, body temperature was 38.3°C. Occasional mild variable and late decelerations with decreased variability were noted. Loss of variability was observed thereafter and was then followed by progressive bradycardia (Figure 1B). An emergency cesarean section was performed. The female infant of 2,822 g was flaccid and resuscitation was immediately started. The infant is alive with flat electroencephalography. Microscopically both funisitis (grade III) and CAM (grade III) were present. All blood vessels in the umbilical cord were encircled by hematoma. Serial sections through the hematoma revealed the destruction of the venous structure. The lesion was located close to the area of the cord insertion into the placenta. Based on the fact that infection and thrombotic lesions were sometimes found in the same placental material 2, the findings of polymorphonuclear leukocyte infiltration by histologic examination of placentas and umbilical cords in our cases strongly suggested that umbilical cord hematoma was associated with CAM and funisitis. We postulate that CAM and funisitis rendered the umbilical vessels friable partly by neutrophilic enzymes, followed by the rupture of the umbilical vein, which is the most common vessel to rupture. Then, clotting took place by the injury of vessel wall, leading to the stenosis or obstruction of the vessel. The hematoma meanwhile spread along Wharton's jelly and compressed the umbilical vessels. Umbilical artery vasospasm might be induced secondary to the cord hematoma 3. Retrospective case reviews revealed that fetal heart rate changes due to the developing hematoma included variable decelerations, late decelerations, and decrease or loss of variability 4. These changes might depend on the severity of the fetal circulatory impairment by umbilical cord hematoma. Severe and persistent bradycardia or subsequent sudden cardiac arrest is usually the final episode. These findings are not specific to umbilical hematoma, and hence, it is difficult to predict by fetal heart tracing. Although prenatal ultrasonography using color Doppler has been shown to diagnose umbilical cord hematoma 5, ultrasonography would be generally of no use without bearing umbilical cord hematoma in mind as a differential diagnosis. In conclusion, umbilical cord hematoma could be attributed to CAM and funisitis. When sudden and prolonged deceleration and subsequent fetal demise or severe asphyxia are encountered without any obvious cause, histological examination of the umbilical cord as well as the placenta should be recommended to clarify the pathogenesis and avoid a needless lawsuit.