Umbilical cord hematoma with altered fetal heart rate. A case report.

A 44-year-old woman, G2P1, with an unremarkable medical history and an uneventful pregnancy course, was seen at 40 weeks’ gestation at our hospital for a routine fetal heart rate (FHR) monitoring at term. The patient referred to a reduction of fetal movements (FM) from early morning. The FHR showed a severe reduced variability of55 b.p.m. and late decelerations; this prompted an emergency caesarean section, with delivery of a female neonate weighing 3,255 g, Apgar scores were 6 at 1 min and 9 at 5 min. A large cord haematoma was evident at the time of caesarean section. The umbilical cord was 49 cm long, with the haematoma (563.762.6 cm at approximately 3 cm from the fetal insertion. The cord showed two arteries and one vein with no other abnormalities in the form of knots loops. Examination of sections through the umbilical cord revealed a recent extravasation of blood into the surrounding Wharton’s jelly caused by rupture of a dilated umbilical artery. The newborn showed tachypnoea, cyanosis and anaemia (Hb: 13.8 g/l) without any other physical or neurological damage. Both mother and baby made a good recovery and were discharged on the fifth postpartum day