Perinatal hemorrhage from ulceration of the umbilical cord: A potentially catastrophic association with duodenal and jejunal obstruction

Aronowitz, Danielle; Dolgin, Stephen E.; Bornstein, Eran; Little-Richardson, Amanda; Bajaj, Jaya; Williamson, Alex; Naves-Ruiz, Esperanza; Edelman, Morris

doi:10.1016/j.jpedsurg.2017.11.045

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…For example, imaging modalities can be used to detect constriction due to malformation of the umbilical insertion. Atresia of the small intestine can lead to ulceration of an umbilical artery near the umbilicus [13][14][15]. These cases all require follow-up with sequential imaging studies performed after the initial diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The Case for Umbilical Cord Screening Via Ultrasound at 18–20 Weeks

Collins¹

2021

MRAJ

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Section: Discussionmentioning

confidence: 99%

The Case for Umbilical Cord Screening Via Ultrasound at 18–20 Weeks

Collins¹

2021

MRAJ

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“…The frequency of umbilical cord ulceration and fetal hemorrhage in fetuses with congenital upper intestinal atresia is estimated to be 15-20% [1, 5, 6]. The typical clinical presentation is preterm labor, nonreassuring fetal heart rate monitoring, and delivery of an anemic infant.…”

Section: Commentmentioning

confidence: 99%

“…The typical clinical presentation is preterm labor, nonreassuring fetal heart rate monitoring, and delivery of an anemic infant. In one literature review of 38 cases there was a 32% incidence of fetal demise, 32% incidence of postnatal death, and an overall survival rate of 37% [1]. Macroscopic features of cord lesions in umbilical cord ulceration are variable and may include ulcers that are single or multiple, linear, helical, or punctate.…”

Section: Commentmentioning

confidence: 99%

“…Umbilical cord ulceration is an unusual lesion characterized by degenerative changes in Wharton's jelly and overlying amnion, thinning of vessel walls, and superficially located, friable vessels prone to hemorrhage. This lesion, its association with congenital upper intestinal (duodenal or jejunal) atresia, and its association with increased perinatal morbidity and mortality have been well documented in the literature; despite this, awareness of this condition and the potential associated lethality remains limited [1]. Because of spontaneous and catastrophic intramniotic bleeding, fetal exsanguination and stillbirth can occur in a high frequency of cases.…”

Section: Introductionmentioning

confidence: 99%

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Hemorrhage from Umbilical Cord Ulceration Identified on Real-Time Ultrasound in a Fetus with Duodenal Atresia

Curtin

Maines

DeAngelis

et al. 2019

Case Reports in Obstetrics and Gynecology

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Umbilical cord ulceration has been associated with congenital upper intestinal (duodenal or jejunal) atresia and can lead to fatal fetal intrauterine hemorrhage. We report a case of spontaneous hemorrhage from the umbilical cord, incidentally noted at the time of ultrasound in a 33-week fetus with suspected duodenal atresia, in which immediate delivery resulted in a good outcome. Despite many reports in the literature of congenital upper intestinal atresia and its association with umbilical cord ulceration, the propensity for this lesion for fetal hemorrhage, and the resulting perinatal morbidity and mortality, there appears to be a gap in the dissemination of this knowledge. In fetuses with suspected congenital upper intestinal atresia, recognition of the entity of umbilical cord ulceration may be improved by ultrasound with special attention to the amount of Wharton’s jelly within the cord. Routine antepartum fetal surveillance may reduce perinatal morbidity and mortality from this condition. A high index of suspicion is needed to make the diagnosis of umbilical cord ulceration in association with congenital upper intestinal atresia. The role of amniotic fluid bile acids in the genesis of this disorder needs further study.

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