Histopathological Findings in Spontaneous Hematoma of the Umbilical Cord

Abstract

Intrinsic anomalies of the cord favored vascular rupture, hematoma of the cord, and acute fetal hypoxia. Placental examination played a key role in excluding medical malpractice because hematoma of the cord was a damaging, not otherwise preventable, event.

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

“…In our analysis of 11 cases, 2 cases showed evidence of chorioamnionitis [ 7 , 8 ], 1 case revealed single umbilical artery and marginal cord insertion with spontaneous avulsion of the umbilical artery [ 5 ], 1 case was secondary to composite heterozygous congenital factor VII deficiency, and in 7 cases no pathological condition was reported [ 3 , 4 , 9 – 11 ].…”

“…Cord hematomas can arise during pregnancy which can lead to fetal death [ 8 ], or may occur, more frequent, during labour giving rise to fetal distress and requiring immediate fetal delivery. Of the nine live born cases discussed in this review, 7 presented at term of gestational age, 2 preterm [ 3 – 5 , 7 , 9 – 11 ]; moreover, 7 cases presented with a complaint of decreased fetal movement [ 3 – 6 , 8 ]. Abnormal fetal heart monitor tracing has been described in 6 cases [ 3 – 6 ].…”

“…It may have a darkish bulge and a bluish discoloration [ 9 ]. Hystopathological examination of the placenta and cord confirmed the presence of hematoma and showed evidence of chorioamnionitis in two cases [ 7 , 8 ]. The hystological examination of the tract of cord affected by the hematoma may show perivascular hemorrhagic infiltration, umbilical vessels compressed by the hemorrhagic effusion, fissures of the venous wall, alterations of the intima and middle tunica with the vessels wall markedly thinned by the reduction of the muscular component and also moderate inflammatory leukocytic infiltration of the umbilical vascular walls [ 12 ].…”

“…Of the 11 cases of spontaneous UCH reported in the 9 studies published in the last 10 years, 2 were stillbirths, 1 occurring antenatally and 1 on day 6 of life [ 6 , 8 ]. Of the nine live born cases, 7 presented at term of gestational age, 2 preterm [ 3 – 5 , 7 , 9 – 11 ].…”