Permissions and Reprints Abstract

Objective Umbilical cord vascular rupture is a rare and severe condition that can occur during labor, leading to adverse outcomes for the fetus before as well as after delivery. Prompt diagnosis and intervention are crucial for improving the chances of a successful outcome. We aimed to analyze cases of umbilical cord vascular rupture during labor to provide insights into this challenging condition.

Study Design This retrospective study evaluated the medical records of patients diagnosed with umbilical cord vessel rupture or umbilical cord hematoma at Fujian Maternity and Child Health Hospital from January 1, 2015, to May 31, 2023. The inclusion criteria included gestational age of ≥28 weeks, occurrence during labor, and availability of complete delivery data. Data on fetal heart rate (FHR) changes, delivery intervals, intraoperative findings, placental pathology, and neonatal outcomes were collected and analyzed.

Results A total of 12 cases were analyzed. The incidence of umbilical cord vascular rupture during childbirth was 0.08%. The FHR patterns in umbilical cord rupture during delivery included baseline tachycardia, minimal or absent variability, variable or late deceleration, prolonged deceleration, and undetectable heart rate. The bradycardia-to-delivery interval (BDI) ranged from 6 to 26 minutes. Among the 12 neonates, 9 were discharged well, 2 were stillbirths, and there was 1 neonatal death. Hemorrhagic shock was common in live births.

Conclusion Our study highlights the significance of continuous FHR monitoring during labor and the urgent need for medical teams to respond quickly in cases of umbilical cord vascular rupture. Despite advancements in neonatal resuscitation techniques, managing cases with undetectable fetal heart activity remains clinically challenging, and even with immediate pregnancy termination, poor neonatal outcomes may still occur.

Key Points

Umbilical cord vascular rupture during labor is a rare event.

Its clinical management presents significant challenges.

Advances in neonatal resuscitation have improved rescue success rates.

In such cases, hemorrhagic shock is common in live births.

Keywords umbilical cord vascular rupture - labor - velamentous cord insertion - fetal heart rate monitoring - emergency response Ethical Approval

Ethics approval for this study was granted by the Ethics Committee of Fujian Maternity and Child Health Hospital (approval no.: 2024KY053).

Authors' Contributions

R.C. conceptualized and designed the study, and curated and analyzed the data with L.L. R.C. wrote the manuscript and conducted a critical review. Both R.C. and L.L. reviewed the final manuscript, giving their approval for publication.

Publication History

Received: 21 August 2024

Accepted: 06 September 2024

Article published online:
01 October 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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