Umbilical cord ulceration: An underdiagnosed entity
Umbilical cord ulceration (UCU) is an under-reported, but important cause of massive fetal hemorrhage which was first reported by Bendon et al. in 1991 [1]. A review of literature revealed only 55 such cases, in which clinically significant intrauterine hemorrhage was produced from UCU occurring in association with fetal intestinal atresia [2]. We report two cases of UCU with the aim to highlight the importance of suspecting and diagnosing these cases during antenatal checkups. This will ensure the segregation of such high risks cases requiring rigorous monitoring and immediate delivery at the first sign of fetal hypoxia. Such a practice may help in improving fetal outcome.
Case Report:
A 28-year-old woman, gravid-three, with previous two uncomplicated term pregnancies came to hospital at 26 weeks of gestation with complaints of pain in abdomen and bleeding per vagina. She had an uneventful antenatal course at a private clinic until admission at our hospital. Abdominal examination revealed a uterine size increased for the gestational age. Fetal heart rate was 110 to 120 beats/min. Vaginal speculum examination showed a closed cervical os with evidence of fresh blood. An emergency ultrasonography revealed a single live intrauterine fetus. "Double bubble" sign, suggestive of duodenal atresia along with polyhydramnios were also present. Placenta was inserted at normal position....