Spontaneous Umbilical Cord Hematoma
A baby girl was born vaginally at 41 weeks and 2 days of gestation after successful induction of labor. The umbilical cord was not traumatized during labor and delivery and was routinely clamped after birth. The girl’s birth weight was 3380 g, and there were no complications.
At birth, results of the physical examination revealed an umbilical cord hematoma (Figure) that measured 3 × 3 × 1.5 cm. The examination results otherwise showed an active baby girl with pink coloration. The girl had some head molding and caput succedaneum, bilateral preauricular tags, and no other dysmorphic features.
The girl had clear lungs, normal heart sounds, no heart murmur, and no organomegaly. Her extremities were symmetrical, and her hips and female genitalia were unremarkable. The girl had a white blood cell count of 29,500/µL, hemoglobin of 21.5 g/dL, hematocrit of 63.9%, and platelets of 154 ×103/µL.
The baby’s mother had received appropriate prenatal care and had had laboratory results that were within reference range. Prenatal ultrasonography results had shown a mildly echogenic fetal bowel, which is considered a normal variant, and this finding had not been detected in subsequent ultrasonography. No other anatomical malformations had been observed prenatally, and a 3-vessel umbilical cord with an unremarkable cord insertion had been identified. The only prenatal finding of note had been a category II fetal heart tracing.
The baby’s postnatal course was unremarkable, and she was discharged home with routine follow up and routine umbilical cord care. The umbilical cord fell off at 12 days of age without any problems, and the baby continues to thrive.
Umbilical cord hematoma is caused by extravasation of venous blood into the Wharton jelly that surrounds the umbilical cord vessels.1 Spontaneous umbilical cord hematoma is rare (1/5500 births), especially in a live birth.2,3 Umbilical cord hematoma is usually responsible for death or severe fetal distress,2-5 which is believed to be a result of compression of the umbilical arteries or from fetal anemia due to blood loss within the cord.6 Risk factors for spontaneous umbilical hematoma are shortness or traction of the cord, postmaturity, and infection. Fetal heart abnormalities have been reported with umbilical cord hematoma.7 The baby girl in our case had a category II fetal heart tracing.
Invasive prenatal procedures can also cause hematoma. A more chronic presentation of a cord hematoma may appear as a mass in the umbilical cord. Doppler studies can evaluate a suspected hematoma, which can increase vascular resistance in the fetus.8 In the case of our patient, the umbilical hematoma was not detected antenatally by fetal sonogram.
If a prenatal diagnosis of cord hematoma is confirmed with a stable fetus, an amniocentesis may be performed, and delivery can be undertaken when the fetus is mature.
Although the literature includes cases with poor outcomes, our case demonstrates a completely asymptomatic baby without any complications. Umbilical cord hematoma is a rare condition that can present along a clinical spectrum from aysmptomatic to severe fetal distress.
Laura Diaz de Ortiz, MD, is a second-year resident in the Department of Pediatrics at Lincoln Medical and Mental Health Center in the Bronx, New York.
Gabriela Echenique, MD, is a third-year resident in the Department of Pediatrics at Lincoln Medical and Mental Health Center in the Bronx, New York.
Magda Mendez, MD, FAAP, is the program director of Lincoln Hospital Pediatrics Department at Lincoln Medical and Mental Health Center in the Bronx, New York.
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