Non-traumatic,
non-inflammatory spontaneous rupture of the umbilical cord vessels prior
to delivery has been reported in 1:5500 births (1).
Majority are due to
rupture of the umbilical vein (67%).
13% are due to rupture
of the umbilical artery.
In 20% of cases all
vessels appear intact and the source of rupture is not identified (3).
Ruptures are usually
secondary to:
Varices (usually
rupture through the amniotic sheath and hemorrhage into the amniotic
fluid with fetal exsanguination) (4,5).
Aneurysms.
Focal thinning of the
vessel wall due to splitting of the elastic membranes (6).
Hematomas of the cord
due to hemorrhage into Wharton's jelly causes compression of the other
vessels and possible anoxia, but does not generally cause rupture (2).
MORTALITY RATE
High (± 45%) (1,7).
REFERENCES
Dippel AL. Hematomas of the umbilical
cord. Surg Gynecol Obstet 1940;70:51.
Summerville JW, Powar JS,
Ueland K. Umbilical cord hematoma resulting in intrauterine demise. L
Reprod Med 1987;32:213.
Clausen I. Umbilical cord
anomalies and antenatal fetal deaths. Obstetrical and Gynecological Survey
1989;44(12):841-845.
Adair FL, McDonald RE. Varix
of the umbilical cord with report of a case. Am J Obstet Gynecol
1929;17:836.
Swanberg H, Wiqvist N.
Rupture of the umbilical cord during pregnancy. Acta Obstet Gynecol Scand
1951;30:323.
Clare NM, Hayashi R, Khodr G.
Intrauterine death from umbilical cord hematoma. Arch Pathol Lab Med
1979;103:46.
Ruvinsky ED, Wiley TL,
Morrison JC, Blake P. In utero diagnosis of umbilical cord hematoma by
ultrasonography. Am J Obstet Gynecol 1981;140:833.