Placenta
Umbilical cord
Hematoma

Reviewer: Paul J. Kowalski, M.D. (see Authors page)

Revised: 17 October 2017, last major update August 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Hematoma [title] umbilical cord
Cite this page: Kowalski, P.J. Hematoma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/placentahematoma.html. Accessed November 19th, 2017.
Definition / general
  • Extravasation of blood from an umbilical vessel that subsequently accumulates in Wharton jelly
Terminology
  • Hematoma or hemorrhage should be distinguished from umbilical cord thrombosis, which can be seen in association with a cord hematoma
Epidemiology
  • Uncommon and estimated to occur in 1 per 5,000 - 13,000 deliveries
Sites
  • Hematomas typically occur at the fetal end of the umbilical cord
Etiology
  • Typically unknown but may be due to a ruptured umbilical vein varix (cystic vascular dilatation), trauma including therapeutic procedures (amniocentesis, cordocentesis, etc.) and cord abnormalities, such as traction occurring with short umbilical cords
Clinical features
  • Blood loss or compression of fetal vessels can lead to circulatory compromise, fetal distress and fetal death
  • Fetal mortality is estimated at 40 - 50% when umbilical cord hematoma is present
Diagnosis
Radiology description
  • Ultrasound can reveal cord expansion with a heteroechoic to hyperechoic mass or discordant umbilical artery Doppler waveforms
Case reports
Treatment
  • Induction of delivery can be undertaken if fetal compromise is present
Clinical images

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Rupture of umbilical vessels

Gross images

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Hematoma of umbilical cord, placenta was delivered by cesarean section, no traction or clamping of this segment of cord

Microscopic (histologic) description
  • Nonspecific and variable hemorrhage involving Wharton jelly
  • Less commonly, evidence of vascular disruption, cystic changes or aneurysmal dilatation