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umbilical cord hematomaFrom: ainsron@msn.comTue Sep 5 20:55:30 2000
Anyone ever seen a spontaneous hematoma of the umbilical cord, causing fetal distress? 33yo G3 P2002, 41 wk 2d, unventful pregnancy, GBS+, Previous C/S, previous VBAC, planning VBAC again. Cx has been really unfavorable until today, now 3cm/vtx/-2, Induction with pitocin followed by amniotomy suggested, but patient wanted to wait until Friday, to be more convenient to husband's schedule. She notes some decreased fetal movement over last 24 hours, therefore sent for NST. NST was nonreactive, 140 range, no decels, no contractions. Then sent for biophysical profile, reported no fetal movement, no fetal breathing, no fluid (<2cm) and no fetal tone, basically your "average" 1/10! On return from radiology, we picked up two decelerations to 80 lasting about 4 minutes, still no contractions and no abdominal pain. Stat C/S called for, of course it was after hours and the on call anesthesiologist was tied up with a high risk patient, 2nd anesthesiologist called in - he was 30 minutes away. Meanwhile I worked at placing the spinal on this 5'9" 300# lady and anesthesia arrived about 5 minutes after it was placed. I didn't go with local because the FHTs had recovered and we were monitoring them throughout the waiting time in the OR. On entering the uterus, there was thick mec, of course and when the baby delivered, a large hematoma was noted on the umbilical cord at the insertion into the baby's umbilicus, 5-6cm in length, 3cm in diameter. Not to hard to imagine why this baby was in distress. The cord had no knots, no nuchal cord, it was not short and in fact was about 70-80 cm long. I haven't got a clue what caused this, just thankful that we got this baby out as quickly as we did and that she didn't wait until tomorrow to do the NST!! APGARS 2/7, cord pH 7.20. Anyone seen anything like this before? That's what keeps us interested, just when you thought you had seen it all...!
-- Ronald E. Ainsworth, MD
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