[Vasa previa: Of the diagnosis to neonatal prognosis]

Benckiser's hemorrhage: about an uncommon case report

Background

Benckiser's hemorrhage is a serious obstetric emergency caused by rupture of one or more umbilical vessels of velamentous insertion, putting the fetus in distress and leading to rapid fetal death through exsanguination in utero. It is an uncommon condition associated with a neonatal mortality rate of 75–100%. This hemorrhage of fetal origin happens most often when the membranes rupture, whether spontaneously or artificially.

This is why prenatal diagnosis via ultrasound can only be beneficial and make it possible to schedule a prophylactic caesarean section before the onset of fetal death as well as other adverse perinatal outcomes.

Case presentation

We hereby present an uncommon case of a 27-year-old female patient, with no antenatal check-ups, who presented to the emergency department for labor-like pain at a gestational age of 32 weeks. On examination, blood pressure was 140/89mmhg. Shortly after her hospitalization, the patient was experiencing steady vaginal bleeding as well as spontaneous rupture of the membranes. Retroplacental hematoma was suspected. It was then quickly decided to do an emergency caesarean section. It was only at the examination of the placenta that the diagnosis was corrected with the visualization of torn velamentous vessels, allowing immediate resuscitation of the newborn and admission in neonatal intensive care unit for blood transfusions.

Conclusions

Detailed prenatal ultrasonography screening for vasa previa in high risk pregnancies prevent the onset of complications related to their rupture. An elective caesarean section should be carried out prior to the onset of labor, most often at 35 weeks of amenorrhea, avoiding rupture of membranes and fetal exsanguination, while taking into consideration the impact of iatrogenic prematurity.

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Routine evaluation of the placental cord insertion site can identify pregnancies with velamentous insertion.

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Prenatal diagnosis makes it possible to schedule a prophylactic cesarean section before the onset of fetal death through exsanguination in utero.

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Diagnosis of Benckiser's hemorrhage allows to orientate towards an immediate neonatal management of hypovolemic shock state.

Neonatal hemorrhagic shock as a consequence of ruptured velamentous vessels – a report of two cases

Background

The objective of the study was to present the rupture of velamentous vessels as a rare but dangerous complication of pregnancy associated with high neonatal risk. Diagnosis of velamentous insertion of umbilical vessels is important to recognize because of the possibility of their rupture during labor. If the condition remains unrecognized, the most important step during labor is prompt and timely treatment of the multidisciplinary team in order to reduce fetal and neonatal mortality and morbidity.

Case presentation

We present two cases of ruptured velamentous vessels, both with good outcomes: in the first case the baby was delivered vaginally after a spontaneous rupture of the velamentous vessels, and in the second case an emergency cesarean section was performed.

Conclusions

Although bleeding caused by the rupture of velamentous vessels is not frequent, the consequences can be serious. The proper diagnosis of the umbilical cord insertion is mandatory during the mid-trimester anomaly scan, but in most cases the condition remains unrecognized until delivery. In the case of a rupture, a prompt reaction of the medical team is crucial in order to save the baby. Sometimes only an urgent 0 Rh negative blood transfusion can avoid a poor neonatal outcome.