RUPTURE OF THE UMBILICAL CORD VESSELS

• Nontraumatic, noninflammatory, spontaneous rupture of the umbilical cord vessels is reported to occur in 1/5500 births (1).
• Ruptures usually occur un:
• varices.
• aneurysms.
• focal thinning of the vessel wall caused by splitting of the elastic membranes (2).
• Unlike the umbilical cord hematoma (where hemorrhage is into Wharton's jelly due to defects in the vessel wall), the hemorrhage associated with rupture of the vessels extends through the amniotic sheath. Hemorrhage thus occurs into the amniotic fluid resulting in fetal demise.
• Rupture of the umbilical vein occurs in 67% of cases.
• Rupture of the umbilical artery occurs in 13% of cases (3,4).
• In 20% of cases all vessels were intact and the source of bleeding not identified.
• Antenatal mortality rate = ± 45%.

REFERENCES

1. Dippel AL. Hematomas of the umbilical cord. Surg Gynecol Obstet 1940;70:51.
2. Clare NM, Hayashi R, Khodr G. Intrauterine death from umbilical cord hematoma. Arch Pathol Lab Med 1979;103:46.
3. Hogg GR, Friesen R. Abnormal umbilical cord with fatal arterial hemorrhage. Am J Obstet Gynecol 1964;83:1251.
4. Summerville JW, Powar JS, Ueland K. Umbilical cord hematoma resulting in intrauterine fetal demise. J Reprod Med 1987;32:213.