Intrauterine hemorrhage from an umbilical cord ulcer associated with fetal duodenal atresia: a case report

In the recent years, the association between congenital intestinal atresia and umbilical cord ulceration has been demonstrated; however, this complication is rarely encountered. To the best of our knowledge, only 14 cases on this association have been published previously. We encountered a case of acute intrauterine hemorrhage from an umbilical cord ulcer in a fetus with duodenal atresia that resulted in early neonatal death. There is little information available on the association between congenital intestinal atresia and umbilical cord ulceration. Greater understanding may alter the obstetric management. Although the prevention of sudden perinatal death is considered to be difficult, frequent fetal monitoring and detailed ultrasonographic examinations may facilitate the early detection of this condition, thereby enabling the rescue of the affected fetuses. Further investigation is required to establish the management protocol.     

Intrauterine umbilical cord hemorrhage with associated jejunal atresia captured by real-time ultrasound

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.     

Umbilical cord ulceration after prenatal diagnosis of duodenal atresia with interstitial deletion of chromosome 13q: a case report

Umbilical cord ulceration complicated by massive local hemorrhage may be a lethal event in the fetus, and this ulceration has been reported to be associated with upper intestinal atresia. The diagnosis of umbilical cord bleeding is difficult. We present a case of umbilical cord ulceration, hemorrhage, and duodenal atresia which had, in addition, an interstitial deletion of chromosome 13q. A female infant weighing 1,691 g was delivered by cesarean section at 34 weeks of gestation and had resuscitation and laparotomy. Just before the cesarean section, ultrasonography showed a 'double bubble' sign and a linear shadow, suggesting fibrin in the amniotic cavity. This finding may help in the diagnosis of bleeding from the cord.     

Sudden fetal death associated with both duodenal atresia and umbilical cord ulcer: a case report and review

We encountered one case of duodenal atresia complicated by massive intrauterine hemorrhage due to the perforation of an umbilical cord ulceration (UCU). UCU is an extremely rare complication in the perinatal period. Although the prenatal diagnosis of upper intestinal atresia has been established, little is known about the association between UCU and upper intestinal atresia. In this article, we report our case, review past articles, and discuss the underlying pathophysiological mechanisms of the cause of an UCU. Given the characteristic sites of upper intestinal atresia, we speculate that regurgitation of gastric or intestinal juice into the amniotic fluid could be responsible for the development of UCU. We also believe that close observation is required for patients who have upper intestinal atresia.     

Sudden fetal hemorrhage from umbilical cord ulcer associated with congenital intestinal atresia

There have been several reports of umbilical cord ulcer (UCU) associated with congenital intestinal atresia, many cases of which have been reported with fetal or neonatal death. Herein is described the case of a fetus with jejunal atresia complicated by acute massive intrauterine hemorrhage due to the perforation of UCU resulting in an intact survival. Although the onset of critical condition in the present case was noted due to continuous fetal heart rate (FHR) monitoring, it is necessary to establish the management of congenital intestinal atresia to prevent this life-threatening fetal hemorrhage.     

Umbilical cord ulcer: a serious in utero complication of intestinal atresia

We have experienced six cases of umbilical cord ulcer that resulted in life-threatening antenatal fetal haemorrhage. Fetal distress and bloody amniotic fluid that led to intrauterine and neonatal death in four patients complicated the pregnancy courses. The remaining two infants are still alive. All the infants had upper intestinal atresia below the papilla of Vater. Pathologically, umbilical arteries and surrounding Wharton's jelly were necrotic in all cases. Activated macrophages containing pigment granules were present within the ulcer bed, necrotic areas of Wharton's jelly and fetal membranes. During the same period, we encountered 38 other cases of upper intestinal atresia and the placentae were examined in 23 cases. Microscopic degeneration of Wharton's jelly was seen in three out of 23 cases. Total bile acids content in amniotic fluid was elevated in one case of umbilical cord ulcer. We speculate that the umbilical cord ulcer is closely related to in utero regurgitation of the bile. We also think that the incidence of this serious association is higher than has been reported previously.     

Umbilical cord ulceration and intestinal atresia: a new association?

In three fetuses, congenital intestinal atresia was associated with linear ulcerations of the umbilical cord. In two cases, hemorrhage was seen from the cord ulcer. Both fetuses required emergency cesarean section for fetal distress and were born anemic. The third fetus was mildly hydropic, attributed to hemorrhage, and was stillborn. The mechanism of the association could not be determined. These cases suggest a risk of prenatal umbilical cord hemorrhage in infants with intestinal atresia.     

Umbilical cord ulcer associated with fetal jejunal atresia: report of 2 cases

We report 2 cases of umbilical cord ulcer associated with fetal jejunal atresia. Both of them developed a severe intrauterine hemorrhage, followed by fetal heart rate decelerations, and underwent emergency cesarean section. Bloody amniotic fluid and umbilical cord ulcers were observed in both cases. Although both cases were successfully resuscitated, neurological impairment and renal failure developed in 1 case due to prolonged asphyxia. In a review of the literature, umbilical cord ulcer was associated only with congenital duodenal atresia or jejunal atresia, but not with ileal atresia. Although the prenatal diagnosis of duodenal or upper jejunal atresia has been established, the prenatal diagnosis of this complication has not been reported. In such cases, detailed examination of the umbilical cord by ultrasonography may be useful for the prenatal diagnosis of this disease.     

Prenatal discovery of an omphalocele associated with an inner umbilical cord Meckel's diverticulum.

The antenatal discovery of Meckel's diverticulum is a rare occurrence; the localization of both Meckel's diverticulum and omphalocele in the umbilical cord has never been described. We present herein a prenatal case of an omphalocele associated with inner umbilical cord dilated Meckel's diverticulum. An umbilical cord cyst was suspected with the cystic image seen during the first trimester exam, and sonography was repeated every month. Several possible diagnoses were discussed including umbilical cord cyst, omphalocele and umbilical cord hernia due to the changing sonographic images during pregnancy. Childbirth had to be arranged at a specialized center. After birth, clamping of the umbilical cord away from the base prevented iatrogenic atresia of the ileum. Surgical treatment had to be arranged during the first days of life.     

Prenatal discovery of an omphalocele associated with an inner umbilical cord Meckel's diverticulum

The antenatal discovery of Meckel's diverticulum is a rare occurrence; the localization of both Meckel's diverticulum and omphalocele in the umbilical cord has never been described. We present herein a prenatal case of an omphalocele associated with inner umbilical cord dilated Meckel's diverticulum. An umbilical cord cyst was suspected with the cystic image seen during the first trimester exam, and sonography was repeated every month. Several possible diagnoses were discussed including umbilical cord cyst, omphalocele and umbilical cord hernia due to the changing sonographic images during pregnancy. Childbirth had to be arranged at a specialized center. After birth, clamping of the umbilical cord away from the base prevented iatrogenic atresia of the ileum. Surgical treatment had to be arranged during the first days of life.     

Intestinal polyp of the umbilical cord

The morphology, pathogenesis, complications and differential diagnosis of an intestinal polyp of the umbilical cord are presented. The polyp were detected postnatal on the umbilical cord in an healthy male newborn. The presents of intestinal tissue upon the umbilical cord ist possible about the persistence from remnants of the ductus omphalomesentericus with prolapse and differentiation of the intestinal cells. The ductus omphalomesentericus is a tubular structure, a communication between the developing embryonic gut and the yolk sac, forming during the early embryonic life. Obliteration of the omphalomesenteric duct is usually complete by the 10(th) week of gestation. Various portions of the duct may persist, however, giving rise to polyps, fistulas or cysts of the umbilical cord with potentially dangerous clinical consequences. Other tumors of the umbilical cord are myxoma, angioma and teratoma are differential diagnosis.     

Umbilical Cord Hernia Mimicking a Cord Teratoma

BackgroundMost umbilical cord masses detected by sonography are angiomyxomas, hematomas, or teratomas. Cord teratomas arise from totipotent stem cells and contain tissue from the three germ-cell layers. Tumour components are foreign to surrounding tissue and may have a polymorphic presentation.CaseWe report a case of a suspected umbilical cord teratoma, identified by sonographic and magnetic resonance imaging, which in fact camouflaged an umbilical cord hernia. The natural history of an omphalocele and umbilical cord hernia dictates the presence of such anterior abdominal wall defects by approximately 12 weeks’ gestation, once the gut returns from the peritoneal space within the umbilical stalk to the peritoneal cavity. Adipose tissue is not described as a classic finding in an omphalocele or umbilical cord hernia.ConclusionOur case of umbilical cord hernia is the first described as strictly distal to, and not contained within, the abdominal wall cord insertion site, and to contain fat, thereby mimicking a cord teratoma.     

A case of single umbilical artery with various fetal anomalies: correlations between prenatal ultrasonographic diagnosis and autopsy

We report a case of a single umbilical artery with various fetal anomalies, and a comparative study between prenatal ultrasonographic diagnosis and autopsy was done. The prenatal ultrasonographic diagnosis included, atrial septal defect (ASD), ventricular septal defect (VSD), mitral atresia or stenosis and a single great vessel. At autopsy, ASD, VSD, mitral atresia, overriding aorta and pulmonary atresia were evident. In case of other anomalies, the findings in the prenatal diagnosis and at autopsy were encephalocele, adrenal hypoplasia and a single umbilical artery. The ultrasonic detection of these anomalies is discussed and the limitations of this diagnostic method are given attention.     

Enteric duplication cyst resembling umbilical cord cyst.

We report a case of a neonatal male with a prenatal diagnosis of umbilical cord cyst that was finally diagnosed as an ileal duplication cyst after post-natal surgical exploration of the umbilical mass. To our knowledge, a similar case has never been reported previously. Although this form of presentation of enteric duplication cyst is exceptional, it should be taken into consideration when evaluating suspected umbilical cord cysts.     

Spontaneous intra-uterine total rupture of a velamentous umbilical cord; a case report

A case of spontaneous intra-uterine total rupture of a velamentous umbilical cord is reported. Shortly after delivery of an exsanguinated stillborn, a completely separated cord was spontaneously delivered. At its insertion the umbilical cord was velamentous, and it consisted of only three vessels at the site of rupture.     

A Truly Knotted Cord

Summary: A case of 4 true knots in an umbilical cord, which did not cause any detectable harm, is presented. Careful examination of the placenta, membranes and umbilical cord continues to be encouraged.     

A Truly Knotted Cord

Summary: A case of 4 true knots in an umbilical cord, which did not cause any detectable harm, is presented. Careful examination of the placenta, membranes and umbilical cord continues to be encouraged.     

Umbilical cord prolapse

Prolapse of the umbilical cord is a rare obstetric emergency that in the viable fetus necessitates an expeditious delivery. A case of a periviable pregnancy complicated by preterm premature rupture of membranes and overt umbilical cord prolapse was prolonged 2 weeks with expectant management is described. An extensive review of the literature regarding the etiology, risk factors, and management options for umbilical cord prolapse in both viable and previable pregnancies accompanies this report.     

Fetal loss from umbilical cord abnormalities--a difficult case for prevention

The summaries of 12 pregnancies in which fetal distress and death were thought to be the result of umbilical cord abnormalities are presented. These included six cases of stricture and torsion of the cord, one case of umbilical vein aneurysm, one case of perivascular haemorrhage near the fetal end of the cord, one case of umbilical vein thrombosis, two cases of true knot of the cord and one case of very short cord. The perinatal mortality was 75% in the whole group (9 out of 12 fetuses), there being eight stillbirths and one neonatal death. Of the 12 fetuses, only three were small for dates at delivery. Nine patients volunteered the history of a decrease in fetal movements, and non-stress cardiotocography (NST) was abnormal in eight patients. It was noted, however, that fetal death tended to occur rapidly after an abnormal test. Observations in our series indicated that antepartum fetal deaths due to umbilical cord abnormalities are still difficult to prevent, as it is often impossible to detect fetal distress in time for appropriate intervention. Prompt action to deliver the baby after an abnormal NST appears to be a necessary step to prevent antepartum deaths due to such causes.     

Nuchal cord type B associated with an excessively long umbilical cord as a cause of stillbirth: a case report

Nuchal cord (NC) is defined as the umbilical cord being wrapped 360 degrees around the fetal neck. It is one of the most common complications of the umbilical cord and any pregnancy might be complicated with a nuchal cord. If a nuchal cord occurs in a pregnant woman with decreased fetal movements, it should be considered to be at high risk, particularly for fetuses with multiple nuchal cords. We report a case in breech presentation with an excessively long umbilical cord (190 cm) which was complicated with five nuchal loops around the fetal neck and resulted in intrauterine death at the 37th week of pregnancy.