Umbilical cord ulceration causing foetal haemorrhage and stillbirth

Symphorosa SC Chan, Amy PK Lau, KF To, TY Leung, TK Lau, TN Leung
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong

We report a case of umbilical cord ulceration associated with obstruction of the duodeno-jejunal junction by a peritoneal band. Umbilical cord ulceration is a rare condition; a literature review identified a total of 17 cases only. In all cases, the ulceration was associated with congenital intestinal obstruction. Cord ulceration usually presents as sudden foetal deterioration due to foetal haemorrhage. This condition is associated with high perinatal mortality and morbidity. The causes of this condition are still unknown, and prenatal diagnosis is difficult. Awareness of the possible association between umbilical cord ulceration and intestinal obstruction, and of the need to deliver such pregnancies immediately when an abnormal foetal heart rate pattern develops might be the only means of preventing intrauterine death and improving neonatal outcomes.

Hong Kong Med J 2008;14:148-51

Key words: Duodenal obstruction; Intestinal atresia; Ulcer; Umbilical cord