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Umbilical cord haematoma as a complication of intrauterine intravascular blood transfusion
Author(s) -
Keckstein Georg,
Tschurtz Sonja,
Schneider Volker,
Mütter Wolfgang,
Terinde Rainer,
Jonatha WolfDietrich
Publication year - 1990
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.1970100109
Subject(s) - medicine , complication , umbilical cord , surgery , gestation , fetus , anesthesia , hematoma , blood transfusion , bradycardia , cord , hydrops fetalis , caesarean section , obstetrics , pregnancy , radiology , blood pressure , anatomy , heart rate , genetics , biology
Between October 1985 and February 1989, 49 ultrasound‐guided intravascular fetal blood transfusions were performed in 16 patients (14 with rhesus (Rh) isoimmunization, 2 with non‐immunologic hydrops fetalis (NIHF)). As an intra‐operative complication, perivascular haematoma of the cord occurred in three patients (7 per cent). In two cases, fetal bradycardia necessitated delivery by Caesarean section at 30 and 32 weeks' gestation, respectively. In the third case, fetal bradycardia developed during transfusion, at 31 weeks' gestation, but normalized within 3 min. The baby was delivered as planned at 36 weeks of gestation, after another transfusion at 34 weeks. Dislodgement of the needle tip into perivascular tissue, caused by sudden fetal or maternal movements, is the reason for this complication. The haematoma develops as a result of delayed recognition and continuous transfusion into Wharton' s jelly. Cord haematoma may be diagnosed in time by continuous ultrasound imaging, as illustrated in case 3. To minimize the risk of needle dislodgement during transfusion, sedation of the mother and complete immobilization of the fetus by injecting a short‐acting muscle relaxant into the umbilical vessel are recommended.