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

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.

Diagnóstico posnatal de hematoma de cordón umbilical. Reporte de un caso

“…El hematoma puede comprometer la circulación materno-fetal al comprimir los vasos (arterias y venas umbilicales), con hipoxia fetal posterior, o por la pérdida de sangre dentro del propio cordón con anemia, lo que conduce a asfixia perinatal y muerte fetal 8 . En nuestro análisis de 15 casos, dos mostraron evidencia de corioamnionitis 10,11 , uno tuvo arteria umbilical única e inserción del cordón marginal con avulsión espontánea de la arteria umbilical 12 , otro se asoció a déficit congénito de factor VII 13 y en 11 casos no se informó ninguna condición patológica 5,8,[14][15][16][17][18][19][20] . La rotura de la vena es más común que la de las arterias (1:10) 13 .…”

“…El diagnóstico suele realizarse tras el nacimiento, pero en algunos casos puede hacerse prenatalmente mediante ecografía Doppler, evaluando el cordón y el flujo sanguíneo en los vasos umbilicales 16,17 . Los hematomas del cordón umbilical pueden surgir durante el embarazo, lo que puede conducir a la muerte fetal 11 , o pueden ocurrir con mayor frecuencia durante el trabajo de parto, lo que genera sufrimiento fetal y requiere una actuación obstétrica inmediata.…”

Spontaneous Umbilical Cord Hematoma

“…In certain cases, the etiology of the hematoma can be a ruptured vein. The ruptured vein can be spontaneous, secondary to the alteration and inflammation of the vessel wall, or secondary to in-utero instrumentations from amniocentesis, fetal transfusions, and fetal diagnostic procedures [ 4 - 5 ].…”

“…Mostly, an umbilical cord hematoma occurs spontaneously and the exact cause is often not detected [ 3 ]. However, the cord anomaly (a short cord, traction, knot, prolapse), iatrogenic (amniocentesis, instrumentation), infection, coagulation disorder, and post maturity should be considered as the potential causes [ 2 , 4 - 5 ]. Nevertheless, most hematomas are difficult to be diagnosed by perinatal ultrasonography and when discovered in utero, it requires higher clinical attention as the rate of fetal demise is high [ 2 ].…”

Corrigendum to “Umbilical Cord Hematoma: A Case Report and Review of the Literature”

“…In the article titled “Umbilical Cord Hematoma: A Case Report and Review of the Literature” [ 1 ], the first and last names of the second author were reversed. The revised authors' list is shown above.…”