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Nagao T, Kuriyama E, Sato A, Yamanaka M. Velamentous cord insertion ruptured during labour leading to acute fetal blood loss. BMJ Case Rep 2021; 14:14/4/e240245. [PMID: 33875500 PMCID: PMC8057559 DOI: 10.1136/bcr-2020-240245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Umbilical cord rupture (UCR) in utero is a very rare and critical emergency that can cause fetal death within minutes. A 38-year-old nulliparous woman was admitted at 39 weeks in labour. Sudden watery vaginal discharge and bleeding with a rapid drop in the fetal heart rate to 60 beats/min necessitated an emergency caesarean section. A male infant weighing 2632 g was delivered 21 min after the onset of bradycardia; Apgar scores were 0 and 1 at 1 and 5 min, respectively. He was extremely pale; the umbilical arterial blood pH was 6.89 and haemoglobin was 9.0 g/dL. The umbilical cord had a velamentous insertion and was lacerated, with haemorrhage in the outer layer of an umbilical artery close to the placental end. The presentation was typical of UCR: vaginal bleeding following the rupture of membranes. Prompt diagnosis of UCR and termination of pregnancy are essential for fetal survival.
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Affiliation(s)
- Takeshi Nagao
- Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan
| | - Erisa Kuriyama
- Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan
| | - Ami Sato
- Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan
| | - Michiko Yamanaka
- Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan
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Nakamura N, Ozawa K, Wada S, Matsuoka K, Yoshioka T, Sugibayashi R, Sago H. Umbilical Cord Ulcer and Intrauterine Death in Fetal Intestinal Atresia. Fetal Diagn Ther 2019; 46:313-318. [PMID: 30870842 DOI: 10.1159/000496840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the incidence of umbilical cord ulcer (UCU) that causes intrauterine fetal death (IUFD) in fetal duodenal or jejunoileal atresia and the association between UCU and bile acid concentrations in amniotic fluid. METHODS Perinatal outcomes were evaluated in cases of fetal intestinal atresia between 2003 and 2017. A pathological examination of the umbilical cord was performed, and bile acid concentrations in the amniotic fluid were measured. RESULTS Among the 46 cases included in this study, there were 27 with duodenal atresia and 19 with jejunoileal atresia. There were 4 cases (8.7%) of IUFD and 1 (2.2%) neonatal death with multiple structural anomalies. UCUs were found in 37.5% (15/40) of cases, and severe UCUs with exposed vessels were significantly more common in IUFD (3/4) than in livebirth (0/42) cases (p < 0.01). The incidences of chromosomal abnormality and structural anomalies were not markedly different between livebirth (9/30 and 11/42, respectively) and IUFD (1/3 and 1/4, respectively) cases. Bile acid concentrations in amniotic fluid were significantly higher in cases of UCUs than in those without (p < 0.01). CONCLUSION UCUs were not rare in fetal intestinal atresia and were associated with high bile acid concentrations in amniotic fluid. UCUs with exposed vessels were associated with IUFD in intestinal atresia.
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Affiliation(s)
- Noriyuki Nakamura
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Katsusuke Ozawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Seiji Wada
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Rika Sugibayashi
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan,
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Hunt J, Schneider C. Mortinaissance attribuable à l'ulcération du cordon ombilical. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:236. [PMID: 30772323 DOI: 10.1016/j.jogc.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jennifer Hunt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
| | - Carol Schneider
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
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Hunt J, Schneider C. Stillbirth Due to Umbilical Cord Erosion. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:235. [PMID: 30772312 DOI: 10.1016/j.jogc.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/31/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jennifer Hunt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB.
| | - Carol Schneider
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynaecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB
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Aronowitz D, Dolgin S, Bornstein E, Little-Richardson A, Bajaj J, Williamson A, Naves-Ruiz E, Edelman M. Perinatal hemorrhage from ulceration of the umbilical cord: A potentially catastrophic association with duodenal and jejunal obstruction. J Pediatr Surg 2018; 53:1669-1674. [PMID: 29241965 DOI: 10.1016/j.jpedsurg.2017.11.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study is to review published reports and contribute new cases of umbilical cord ulceration (UCU) with perinatal hemorrhage into the amniotic cavity in the setting of duodenal or jejunal obstruction because knowledge of this sequence is poorly disseminated and could be lifesaving. METHODS Published reports of UCU with hemorrhage associated with congenital duodenal or jejunal obstruction were reviewed. Chart review was conducted for the cases encountered at our institutions between January 2008 and March 2017. We noted perinatal complications, method of delivery, gestational age, birth weight, gender, number, location, and pathologic description of umbilical cord ulcers, and outcome. RESULTS Thirty-one reports and 7 new cases were studied. Perinatal complications included: preterm labor or preterm premature rupture of membranes: 63%; fetal distress: 95%; mean gestational age: 33weeks; premature gestation: 95%; bloody amniotic fluid: 90%. Pathological analysis of UCUs revealed solitary, multifocal, helical and punched-out lesions. There were 12 neonatal deaths (32%), and 12 intrauterine deaths (32%). Survival rate was 37%. CONCLUSIONS UCU with perinatal hemorrhage is associated with duodenal and jejunal obstruction. Knowing the typical clinical signs of this potential catastrophic complication could prompt lifesaving delivery. TYPE OF STUDY Prognostic LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Stephen Dolgin
- Division of Pediatric General, Thoracic and Endoscopic Surgery, Cohen Children's Medical Center, New Hyde Park, NY; Lenox Hill Hospital, New York, NY.
| | - Eran Bornstein
- Division of Maternal/Fetal Medicine, Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY
| | - Amanda Little-Richardson
- Division of Maternal/Fetal Medicine, Obstetrics and Gynecology, Lenox Hill Hospital, New York, NY
| | - Jaya Bajaj
- Division of Anatomical Pathology, Pediatric Pathology, Cohen Children's Medical Center, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | - Alex Williamson
- Division of Anatomical Pathology, Pediatric Pathology, Cohen Children's Medical Center, Hofstra-Northwell School of Medicine, New Hyde Park, NY
| | | | - Morris Edelman
- Division of Anatomical Pathology, Pediatric Pathology, Cohen Children's Medical Center, Hofstra-Northwell School of Medicine, New Hyde Park, NY
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Nakamura E, Samejima K, Takayanagi N, Ono Y, Matsunaga S, Nagai T, Takai Y, Saitoh M, Baba K, Seki H. Retrospective study of umbilical cord ulceration related to congenital intestinal atresia: A single-center report. J Obstet Gynaecol Res 2018. [PMID: 29516584 DOI: 10.1111/jog.13611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Umbilical cord ulceration (UCU) is a disease in which an ulcer forms in the umbilical cord in the pregnant uterus and is accompanied by hemorrhaging from the same site. UCU occurs in fetuses with congenital upper-intestinal atresia (CUIA); however, its onset mechanism remains unclear. Here, we report our investigation of cases of UCU in our hospital. METHODS Among the 9825 deliveries performed between 2007 and 2016 at this hospital, 20 fetuses were diagnosed with CUIA, 4 (20%) of which had UCU. There was no difference in the backgrounds of the fetuses with UCU (UCU group: 4 fetuses) and those without (non-UCU group: 16 fetuses). RESULTS There was no intergroup difference in gestational age at delivery. Four cases in the UCU group had maternal age 35 weeks (26-39), weeks of delivery 35 weeks (35-36) and weight 2178.5 g (1600-2640); three out of four fetuses were female; and the location of gastrointestinal obstruction was in the duodenum in one case and in the jejunum in three cases. Death occurred in three of four fetuses in the UCU group versus none in the non-UCU group. CONCLUSION We performed a retrospective statistical investigation on the risk of UCU onset in cases from this hospital; however, we could not identify any prognostic factors for its onset. We investigated a total of 27 past reported UCU cases and the 4 cases in this study. Mean gestational age at onset was 33.3 ± 2.7 for all 27 cases. Various methods for the early discovery of UCU have been reported in the past; however, there is currently no gold standard. Based on this report and a review of past papers, for CUIA, it is desirable to perform in-hospital management from gestational week 30 onward and decide proper delivery timing on a case-by-case basis.
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Affiliation(s)
- Eishin Nakamura
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kouki Samejima
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yoshihisa Ono
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shigetaka Matsunaga
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomonori Nagai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasushi Takai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masahiro Saitoh
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazunori Baba
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Seki
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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Nijagal A, Rand L, Goldstein R, Poder L, Miniati D. Intrauterine umbilical cord hemorrhage with associated jejunal atresia captured by real-time ultrasound. Am J Obstet Gynecol 2009; 200:e5-6. [PMID: 18992865 DOI: 10.1016/j.ajog.2008.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/17/2008] [Indexed: 12/11/2022]
Abstract
The presence of unexplained umbilical cord ulceration and hemorrhage has been sporadically reported in fetuses with antenatally suggested intestinal atresia. This case report illustrates a patient with spontaneous intrauterine umbilical cord hemorrhage, captured by real-time ultrasonography, in the setting of jejunal atresia with volvulus of the distal jejunal segment.
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Affiliation(s)
- Amar Nijagal
- Division of Pediatric Surgery, University of California, San Francisco, CA 94143-0570, USA
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