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Zhang W, Yang T, Zhang F, Liao X, Kong J, Mai C, Li D. Fetal movement during delivery can lead to damage to the umbilical vessels and endanger the life of the fetus. Leg Med (Tokyo) 2024; 70:102493. [PMID: 39018795 DOI: 10.1016/j.legalmed.2024.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/28/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION Fetal umbilical cord hematoma has a low incidence but high mortality, and its cause during delivery is often unclear. We report an autopsy case in which it was concluded that umbilical cord hematoma resulted from fetal movements during childbirth. CASE PRESENTATION AND AUTOPSY FINDINGS A 27-year-old primigravida at 39 + 2 weeks gestation with normal antenatal visits suffered a fetal heart rate decrease during active labor. Bedside ultrasound revealed fetal death in utero 22 min later. Forensic pathologists found that the umbilical vessels were torn and bleeding on almost the same plane, and the hematoma compressed both umbilical arteries, which is the cause of fetal stillness in utero. A total of 32 cases were reported, including 6 umbilical cord ruptures and 26 umbilical cord hematomas. The cause of hematoma was unknown in 77 % of cases, while dysplasia was present in 56.25 % of umbilical cords. DISCUSSION This case indicates that fetal movements may cause umbilical cord vessel injury, particularly when oxytocin is used to induce labor. When fetal heart sounds decrease for no apparent reason, the possibility of cord injury should be considered, and cesarean delivery should be performed as soon as possible. Therefore, rigorous fetal heart tracing during active delivery is necessary.
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Affiliation(s)
- Weicheng Zhang
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Tengfei Yang
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Fu Zhang
- Guangdong Public Security Department, Guangzhou, China
| | - Xinbiao Liao
- Guangdong Public Security Department, Guangzhou, China
| | - Jiangwei Kong
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China
| | - Caixiu Mai
- Department of Obstetrics, Shunde Hospital, Southern Medical University, Foshan, China
| | - Dongri Li
- Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China.
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Ebbing C, Rasmussen S, Kessler J, Moster D. Association of placental and umbilical cord characteristics with cerebral palsy: national cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:224-230. [PMID: 36722428 PMCID: PMC10108292 DOI: 10.1002/uog.26047] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Cerebral palsy (CP) is a group of movement disorders usually diagnosed in childhood. A substantial proportion are thought to be caused by antenatal events. Abnormalities of the umbilical cord and placenta are associated with an increased risk of adverse neonatal outcomes, but it is unclear whether these conditions also carry an increased risk of CP. We aimed to determine whether abnormalities of the umbilical cord or placenta are associated with CP and assess if these associations differ by sex of the child or gestational age at birth. METHODS We performed a national cohort study by linking data from The Medical Birth Registry of Norway with other national registries. All liveborn singletons born between 1999 and 2017 (n = 1 087 486) were included and followed up until the end of 2019. Diagnoses of CP were provided by the Norwegian National Insurance Scheme and the Norwegian Patient Register. We used generalized estimating equations and multilevel log binomial regression to calculate relative risks (RR), adjusted for year of birth, and stratified analyses were carried out based on sex and gestational age at birth. Exposures were abnormal umbilical cord (velamentous or marginal insertion, single umbilical artery (SUA), knots and entanglement), and placental abnormalities (retained placenta, placental abruption and previa). RESULTS A total of 2443 cases with CP (59.8% males) were identified. Velamentous cord insertion (adjusted RR (aRR), 2.11 (95% CI, 1.65-2.60)), cord knots (aRR, 1.53 (95% CI, 1.15-2.04)) and placental abnormalities (placenta previa (aRR, 3.03 (95% CI, 2.00-4.61)), placental abruption (aRR, 10.63 (95% CI, 8.57-13.18)) and retained placenta (aRR, 1.71 (95% CI, 1.32-2.22))) carried an increased risk of CP. Velamentous cord insertion was associated with CP regardless of gestational age or sex. A retained placenta was associated with a 2-fold increased risk for CP in males, while the associations of SUA and cord knot with CP were significant only among females. CONCLUSIONS The detection of placental and umbilical cord abnormalities may help identify children at increased risk of CP. The associations between placental or umbilical cord abnormalities and the risk of CP do not vary substantially with gestational age at birth or sex of the child. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Ebbing
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - S. Rasmussen
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - J. Kessler
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - D. Moster
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Department of PediatricsHaukeland University HospitalBergenNorway
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Naeem A, Rahman S, Abdulghani M, Almalki Y. Down syndrome with umbilical cord hematoma: Case report and review of literature. J Clin Neonatol 2023. [DOI: 10.4103/jcn.jcn_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord. Medicina (B Aires) 2022; 58:medicina58121754. [PMID: 36556956 PMCID: PMC9782481 DOI: 10.3390/medicina58121754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton's jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein.
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Vuong ADB, Nguyen PN. Umbilical Cord Haematoma and Uterine Torsion: Rare Pregnancy Complications at Tu Du Hospital in Vietnam and a Review of Literature. EUROPEAN MEDICAL JOURNAL 2022. [DOI: 10.33590/emj/10009645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Anh Dinh Bao Vuong
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
| | - Phuc Nhon Nguyen
- Department of High-Risk Pregnancy, Tu Du Hospital, Ho Chi Minh City, Vietnam
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Sherer DM, Al-Haddad S, Cheng R, Dalloul M. Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology. Int J Womens Health 2021; 13:939-971. [PMID: 34703323 PMCID: PMC8541738 DOI: 10.2147/ijwh.s278747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022] Open
Abstract
The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton’s jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl’s anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.
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Affiliation(s)
- David M Sherer
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sara Al-Haddad
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Regina Cheng
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mudar Dalloul
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
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Abstract
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.
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Affiliation(s)
- Pratichhya Khatiwada
- Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Mohammed Alsabri
- Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Salome Wiredu
- Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Viswanathan Kusum
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Vohra Kiran
- Department of Neonatology, Brookdale University Hospital Medical Center, Brooklyn, USA
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Pezron J, Tellai L, Tourneux P. Spontaneous umbilical cord hematoma with a favorable outcome. Arch Pediatr 2020; 27:380-382. [PMID: 32893110 DOI: 10.1016/j.arcped.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/16/2020] [Accepted: 07/24/2020] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- J Pezron
- Réanimation pédiatrique, centre hospitalier universitaire d'Amiens-Picardie, 1, rue du Professeur Christian Cabrol, 80054 Amiens, France
| | - L Tellai
- Néonatalogie, centre hospitalier de Laon (Hauts-de-France), 80054 Amiens, France
| | - P Tourneux
- Réanimation pédiatrique, centre hospitalier universitaire d'Amiens-Picardie, 1, rue du Professeur Christian Cabrol, 80054 Amiens, France; PériTox UMI-01, UFR médecine, université de Picardie Jules Verne, 80054 Amiens, France.
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9
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Risk factors for spontaneous hematoma of the umbilical cord: A case-control study. Placenta 2020; 99:152-156. [PMID: 32798767 DOI: 10.1016/j.placenta.2020.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Spontaneous hematomas of the umbilical cord are rare and often fatal to the fetus. Little is known about their mechanism or their risk factors. In view of their rarity, the series are limited. No comparative study enabling the identification of factors associated with these hematomas has been published. MATERIAL AND METHODS This retrospective case-control study of 13 spontaneous histologically confirmed hematomas of the umbilical cord over a consecutive 16-year period compared the characteristics of the case mothers and fetuses to those of a group of 39 control mothers who gave birth the same day as the case mothers. RESULTS In utero death was high in the case group (46.2% vs 0.0%, P < 0.001). Third-trimester oligohydramnios (30.8 vs 2.6%, OR = 16.9, P = 0.01), second-trimester amniocentesis (33.3 vs 5.1%, OR = 9.3, P = 0.02), and a reduction in fetal movements as perceived by the mother (35.7 vs 7.7%, P = 0.02) were significantly associated with spontaneous umbilical cord hematomas. CONCLUSION Third-trimester oligohydramnios and second-trimester amniocentesis appear to be associated with the occurrence of a spontaneous hematoma of the umbilical cord.
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Ebbing C, Kessler J, Moster D, Rasmussen S. Single umbilical artery and risk of congenital malformation: population-based study in Norway. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:510-515. [PMID: 31132166 DOI: 10.1002/uog.20359] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/06/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Single umbilical artery (SUA) is associated with congenital malformations in most organ systems, but reported findings have not been consistent. While it has been suggested that genetic and persisting environmental factors influence the development of SUA, it is not known whether there is an increased risk of recurrence in a subsequent pregnancy of the same woman. The aims of this study were to investigate the occurrence of, and risk factors for, SUA in Norway, to assess its association with congenital malformations and trisomies 13, 18 and 21 and to study the risk of recurrence of SUA in subsequent pregnancies. METHODS This was a population-based study of all (n = 918 933) singleton pregnancies of > 16 weeks' gestation recorded in the Medical Birth Registry of Norway from 1999 to 2014. To identify risk factors and congenital malformations associated with SUA, generalized estimating equations and logistic regression were used to calculate odds ratios (OR) with 95% CIs. ORs were also calculated for the recurrence of SUA in subsequent pregnancy. RESULTS The occurrence of SUA in our population was 0.46% (4241/918 933). Parity ≥ 4, smoking, maternal pregestational diabetes, epilepsy, chronic hypertension, previous Cesarean delivery and conception by assisted reproductive technology increased the odds of having SUA. There was a particularly strong association between SUA and gastrointestinal atresia or stenosis in the neonate, with ORs of 25.8 (95% CI, 17.0-39.1) and 20.3 (95% CI, 13.4-30.9) for esophageal and anorectal atresia or stenosis, respectively, followed by an OR of 5.9 (95% CI, 1.9-18.5) for renal agenesis. SUA was associated with an up to 7-8 times increased risk of congenital heart defects. There was an association with microcephaly, congenital hydrocephalus and other congenital malformations of the brain and spinal cord. Diaphragmatic hernia, limb reductions and cleft lip or palate had a weaker association with SUA, with ORs ranging from 4.8 to 2.8. The associations with trisomy 18 and 13 were equally strong (OR 14.4 (95% CI, 9.3-22.4) and OR 13.6 (95% CI, 6.7-27.8), respectively), and the risk of trisomy 21 was doubled (OR 2.1 (95% CI, 1.2-3.6)). Pregnancies with SUA, with or without an associated malformation, had a 2-fold increased risk for SUA in a subsequent pregnancy. CONCLUSIONS SUA is associated strongly with gastrointestinal atresia or stenosis, suggesting common developmental mechanisms. The increased risk of recurrence of SUA suggests that genetic and/or persisting environmental factors influence the risk. We found that SUA had equally strong associations with trisomies 13 and 18. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - J Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - D Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - S Rasmussen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Ebbing C, Kessler J, Moster D, Rasmussen S. Isolated single umbilical artery and the risk of adverse perinatal outcome and third stage of labor complications: A population-based study. Acta Obstet Gynecol Scand 2019; 99:374-380. [PMID: 31603530 DOI: 10.1111/aogs.13747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/26/2019] [Accepted: 10/07/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Isolated single umbilical artery (iSUA) refers to single umbilical artery cords with no other fetal malformations. The association of iSUA to adverse outcome of pregnancy has not been consistently reported, and whether iSUA carries increased risk of third stage of labor complications has not been studied. We aimed to investigate the risk of adverse perinatal outcome, third stage of labor complications, and associated placental and cord characteristics in pregnancies with iSUA. A further aim was to assess the risk of recurrence of iSUA and anomalous cord or placenta characteristics in Norway. MATERIAL AND METHODS This was a population-based study of all singleton pregnancies with gestational age >16 weeks at birth using data from the Medical Birth Registry of Norway from 1999 to 2014 (n = 918 933). Odds ratios (OR) with 95% confidence intervals were calculated for adverse perinatal outcome (preterm birth, perinatal and intrauterine death, low Apgar score, transferral to neonatal intensive care ward, placental and cord characteristics [placental weight, cord length and knots, anomalous cord insertion, placental abruption and previa]), and third stage of labor complications (postpartum hemorrhage and the need for manual placental removal or curettage) in pregnancies with iSUA, and recurrence of iSUA using generalized estimating equations and logistic regression. RESULTS Pregnancies with iSUA carried increased risk of adverse perinatal outcome (OR 5.06, 95% confidence interval [CI] 4.26-6.02) and perinatal and intrauterine death (OR 5.62, 95% CI 4.69-6.73), and a 73% and 55% increased risk of preterm birth and small-for-gestational-age neonate, respectively. The presence of iSUA also carried increased risk of a small placenta, placenta previa and abruption, anomalous cord insertion, long cord, cord knot and third stage of labor complications. Women with iSUA, long cord or anomalous cord insertion in one pregnancy carried increased risk of iSUA in the subsequent pregnancy. CONCLUSIONS The presence of ISUA was associated with a more than five times increased risk of intrauterine and perinatal death and with placental and cord complications. The high associated risk of adverse outcome justifies follow up with assessment of fetal wellbeing in the third trimester, intrapartum surveillance and preparedness for third stage of labor complications.
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Affiliation(s)
- Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Jörg Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Dag Moster
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Svein Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
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12
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Mota F, Oliveira N, Fonseca M, Mimoso G. Spontaneous umbilical cord haematoma. BMJ Case Rep 2019; 12:12/6/e229952. [PMID: 31217216 DOI: 10.1136/bcr-2019-229952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Fábia Mota
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Pediatric Unit, Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal
| | - Nuno Oliveira
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Pediatric Unit, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Margarida Fonseca
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gabriela Mimoso
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Krzyżanowski A, Kwiatek M, Gęca T, Stupak A, Kwaśniewska A. Modern Ultrasonography of the Umbilical Cord: Prenatal Diagnosis of Umbilical Cord Abnormalities and Assessement of Fetal Wellbeing. Med Sci Monit 2019; 25:3170-3180. [PMID: 31036798 PMCID: PMC6505057 DOI: 10.12659/msm.913762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The umbilical cord is the only connection between the mother and the fetus, through which it is possible to transport respiratory gases, nutrients, and metabolites. Thanks to the umbilical cord, the fetus has also the ability to move, which is necessary for its proper psychomotor development. The correct structure and function of umbilical vessels and the entire umbilical cord determine the possibility of proper development and survival of the fetus. Umbilical cord anatomy should be assessed in the ultrasound examination in the first trimester. It is of vital importance to confirm the correct number of umbilical vessels and their intra-abdominal course, as well as carefully assessing the abdominal and placental insertion sites. In the latter half of pregnancy, the use of the Doppler imaging enables assessment of the function of the fetal-placental vessels, thus providing valuable information about the condition of the fetus.
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Affiliation(s)
- Arkadiusz Krzyżanowski
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Lublin, Poland
| | - Maciej Kwiatek
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Lublin, Poland
| | - Tomasz Gęca
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Stupak
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Lublin, Poland
| | - Anna Kwaśniewska
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, Lublin, Poland
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Umbilical Cord Hematoma: A Case Report and Review of the Literature. Obstet Gynecol Int 2018; 2018:2610980. [PMID: 29780421 PMCID: PMC5892214 DOI: 10.1155/2018/2610980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/21/2018] [Indexed: 11/17/2022] Open
Abstract
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.
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Feng D, He W. Spontaneous umbilical artery haematoma diagnosed in the third trimester: a case report. J OBSTET GYNAECOL 2018; 38:576-577. [PMID: 29385858 DOI: 10.1080/01443615.2017.1379966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dan Feng
- Department of Obstetrics and Gynecology, Chengdu Women & Children’s Central Hospital, Chengdu, China
| | - Wei He
- Department of Obstetrics and Gynecology, Chengdu Women & Children’s Central Hospital, Chengdu, China
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16
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Arora PK, Mohandas S, McAndrew S, Karody V. Spontaneous Umbilical Cord Hematoma. J Pediatr 2017; 184:233-233.e1. [PMID: 28196683 DOI: 10.1016/j.jpeds.2017.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Puneet Kumar Arora
- Division of Neonatology Children's Hospital of Wisconsin Wauwatosa, Wisconsin
| | - Sindhu Mohandas
- Division of Pediatric Infectious Diseases The Children's Hospital at Montefiore New York, New York
| | - Sarah McAndrew
- Division of Neonatology Children's Hospital of Wisconsin Wauwatosa, Wisconsin
| | - Vijender Karody
- Division of Neonatology Children's Hospital of Wisconsin Wauwatosa, Wisconsin
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17
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Koukoura O, Sveronis G, Alevra Z, Gaitana K, Kalaitzi AN, Dafoulis N, Karasavidou F, Garas A, Daponte A. Spontaneous cord hematoma: report of two cases. CASE REPORTS IN PERINATAL MEDICINE 2016. [DOI: 10.1515/crpm-2015-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Spontaneous hematoma of the umbilical cord due to rupture of an umbilical cord vessel is a rare obstetrical complication which represents a severe cause of fetal distress with a 50% of reported fetal demise. Although several risk factors have been suggested, the cause of this disorder remains unknown. Herein we describe two cases of term deliveries with spontaneous umbilical cord hematomas which resulted in live births. In both cases the diagnosis was made intrapartum and was confirmed by a histopathologic examination.
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Affiliation(s)
- Ourania Koukoura
- Obstetrics and Gynecology Department, University Hospital of Larissa , Larissa, Thessaly, Greece
| | - George Sveronis
- Obstetrics and Gynecology Department, University Hospital of Larissa , Larissa, Thessaly, Greece
| | - Zoi Alevra
- Obstetrics and Gynecology Department, University Hospital of Larissa , Larissa, Thessaly, Greece
| | - Katerina Gaitana
- Neonatal Intensive Care Unit, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa , Greece
| | - Anna N. Kalaitzi
- Neonatal Intensive Care Unit, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa , Greece
| | - Nikolaos Dafoulis
- Department of Anesthesiology, University of Larissa , Larissa, Greece
| | - Fotini Karasavidou
- Department of Pathology , School of Medicine, University of Thessaly , Larissa, Greece
| | - Antonios Garas
- Obstetrics and Gynecology Department, University Hospital of Larissa , Larissa, Thessaly, Greece
| | - Alexandros Daponte
- Obstetrics and Gynecology Department, University Hospital of Larissa , Larissa, Thessaly, Greece
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18
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McAdams RM, Chabra S. Umbilical cord haematoma and adrenal haemorrhage in a macrosomic neonate with anaemia. BMJ Case Rep 2016; 2016:bcr-2015-214140. [PMID: 26843224 DOI: 10.1136/bcr-2015-214140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Shilpi Chabra
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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19
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Histopathological Findings in Spontaneous Hematoma of the Umbilical Cord. Am J Forensic Med Pathol 2015; 36:254-6. [DOI: 10.1097/paf.0000000000000195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Abraham A, Rathore S, Gupta M, Benjamin SJ. Umbilical Cord Haematoma Causing Still Birth- A Case Report. J Clin Diagn Res 2015; 9:QD01-2. [PMID: 26816950 PMCID: PMC4717679 DOI: 10.7860/jcdr/2015/16106.6856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 09/05/2015] [Indexed: 11/24/2022]
Abstract
Still birth continues to be one of the many challenges that an obstetrician has to face. Still births that occur in the antenatal period are more difficult to explain than that which occurs intrapartum. The latter is most often due to intrapartum asphyxia, medical complications or infections; however a cause for antenatal still birth is difficult to ascertain. A thorough examination of the case along with necessary investigations might not necessarily reveal any cause and this leads to considerable anxiety for both the mother and the treating obstetrician. In the investigation of a case of still birth a detailed examination of the placenta and cord has to be emphasised as a considerable number of still births that are thought to be unexplained may be attributable to placental or cord pathologies. Here we present one such case where an umbilical cord haematoma resulted in intrauterine foetal death.
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Affiliation(s)
- Anuja Abraham
- Assistant Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Swati Rathore
- Assistant Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mayank Gupta
- Assistant Professor, Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Joseph Benjamin
- Associate Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
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21
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Moshiri M, Zaidi SF, Robinson TJ, Bhargava P, Siebert JR, Dubinsky TJ, Katz DS. Comprehensive imaging review of abnormalities of the umbilical cord. Radiographics 2015; 34:179-96. [PMID: 24428290 DOI: 10.1148/rg.341125127] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making.
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Affiliation(s)
- Mariam Moshiri
- From the Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195 (M.M., S.F.Z., T.J.R., P.B., T.J.D.); Department of Radiology, VA Puget Sound Health Care System, Seattle, Wash (P.B.); Department of Laboratories, Seattle Children's Hospital, Seattle, Wash (J.R.S.); and Department of Radiology, Winthrop-University Hospital, Mineola, NY (D.S.K.)
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