Archives of Gynecology and Obstetrics

, Volume 275, Issue 3, pp 219–222 | Cite as

Intrauterine hemorrhage from an umbilical cord ulcer associated with fetal duodenal atresia: a case report

Case Report

Abstract

In the recent years, the association between congenital intestinal atresia and umbilical cord ulceration has been demonstrated; however, this complication is rarely encountered. To the best of our knowledge, only 14 cases on this association have been published previously. We encountered a case of acute intrauterine hemorrhage from an umbilical cord ulcer in a fetus with duodenal atresia that resulted in early neonatal death. There is little information available on the association between congenital intestinal atresia and umbilical cord ulceration. Greater understanding may alter the obstetric management. Although the prevention of sudden perinatal death is considered to be difficult, frequent fetal monitoring and detailed ultrasonographic examinations may facilitate the early detection of this condition, thereby enabling the rescue of the affected fetuses. Further investigation is required to establish the management protocol.

Keywords

Umbilical cord ulcer Duodenal atresia Intrauterine hemorrhage Wharton’s jelly 

References

  1. 1.
    Bendon RW, Tyson RW, Baldwin VJ, Cashner KA, Mimouni F, Miodovnik M (1991) Umbilical cord ulceration and intestinal atresia: a new association? Am J Obstet Gynecol 164:582–586PubMedGoogle Scholar
  2. 2.
    Khong TY, Ford WDA, Haan EA (1994) Umbilical cord ulceration in association with intestinal atresia in a child with detection 13q and Hirschsprung’s disease. Arch Dis Child Fetal Nenatal Ed 71:F212–213CrossRefGoogle Scholar
  3. 3.
    Khurana A, Huettner PC, Cole FS (1995) Umbilical cord ulceration as a cause of hypoxic-ischemic encephalopathy: report of a case and review of the literature. J Perinatol 15:423–425PubMedGoogle Scholar
  4. 4.
    Yamanaka M, Ohyama M, Koresawa M, Kawataki M, Ohsaki I, Tanaka Y (1996) Umbilical cord ulceration and intestinal atresia. Eur J Obstet Gynecol Reprod Biol 70: 209–212PubMedCrossRefGoogle Scholar
  5. 5.
    Ohyama M, Itani Y, Yamanaka M, Imaizumi K, Nishi T, Ijiri R, Tanaka Y (2000) Umbilical cord ulcer: a serious in utero complication of intestinal atresia. Placenta 21:432–435PubMedCrossRefGoogle Scholar
  6. 6.
    Shimizu S, Kawagishi R, Wada K, Ishida E, Shimoya K, Murata Y (2003) Fetal hemorrhage associated with congenital intestinal atresia. J Obstet Gynecol Res 29:312–316 CrossRefGoogle Scholar
  7. 7.
    Anami A, Morokuma S, Tsukimori K, Kondo H, Satoh S, Nozaki M, Sueishi K, Nakano H (2006) Sudden fetal death associated with both duodenal atresia and umbilical cord ulcer, a case and review. Am J Perinatol 23:183–188PubMedCrossRefGoogle Scholar
  8. 8.
    Murshed R, Nicholls G, Spitz L (1999) Intrinsic duodenal obstruction: trends in management and outcome over 45 years (1951–1995) with relevance to prenatal counseling. Br J Obstet Gynaecol 106:1197–1199PubMedGoogle Scholar
  9. 9.
    Bittencourt DG, Barini R, Marba S, Sbragia L (2004) Congenital duodenal obstruction: does prenatal diagnosis improve the outcome? Pediatr Surg Int 20:582–585PubMedCrossRefGoogle Scholar
  10. 10.
    Haeusler MC, Berghold A, Stoll C, Barisic I, Clementi M (2002) Prenatal ultrasonographic detection of gastrointestinal obstruction: result from 18 European congenital anomaly registries. Prenat Diagn 22:616–623PubMedCrossRefGoogle Scholar
  11. 11.
    Phelps S, Fisher R, Partington A, Dykes E (1997) Prenatal ultrasound diagnosis of gastrointestinal malformations. J Pediatr Surg 32:438–440PubMedCrossRefGoogle Scholar
  12. 12.
    Grosfeld JL, Rescorla FJ (1993) Duodenal atresia and stenosis: reassessment of treatment and outcome based on antenatal diagnosis, pathologic variance, and long-term follow-up. World J Surg 17:133–135Google Scholar
  13. 13.
    Akhtar J, Guiney EJ (1992) Congenital duodenal obstruction. Br J Surg 79:133–135PubMedGoogle Scholar
  14. 14.
    Romero R, Ghidini A, Costigan K, Touloukian R, Hobbins JC (1988) Prenatal diagnosis of duodenal atresia: does it make any difference? Obstet Gynecol 71:739–741PubMedGoogle Scholar
  15. 15.
    Brantberg A, Blaas HG, Salvesen KA, Haugen SE, Mollerlokken G, Eik-Nes SH (2002) Fetal duodenal obstructions: increased risk of prenatal sudden death. Ultrasound Obstet Gynecol 20:439–446PubMedCrossRefGoogle Scholar
  16. 16.
    Ghezzi F, Raio L, Dinaro E, Franchi M, Balestreri D, D’addario V (2001) Nomogram of Wharton’s jelly as depicted in the sonographic cross section of the umbilical cord. Ultrasound Obstet Gynecol 18:121–125PubMedCrossRefGoogle Scholar
  17. 17.
    Weissman A, Jakobi P, Bronshtein M, Goldstein I (1994) Sonographic measurements of the umbilical cord and vessels during normal pregnancies. J Ultrasound Med 13:11–14PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of PerinatologyNational Cardiovascular CenterOsakaJapan
  2. 2.Department of Obstetrics and Gynecology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.FukuokaJapan

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