Li Pei-Chen, Ding Dah-Ching
Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
Medicine (Baltimore). 2018 Nov;97(45):e13221. doi: 10.1097/MD.0000000000013221.
We report a rare case of a pregnant woman with cord prolapse, velamentous cord insertion (VCI), and fetal vertex presentation who completed vaginal delivery.
Without having undergone regular antepartum examinations, a 31-year-old pregnant woman, gravida 6, para 4, abortion 1, presented at 37 weeks and 3 days of gestation. She had regular labor pain and bloody show.
Cord prolapse during labor and VCI after delivery.
Per vaginal examination at 11:20 PM revealed a fully dilated cervix. Thirty minutes later, artificial rupture of the membrane was performed, and an overt prolapsed cord approximately 10-cm long was palpated in the vagina. Fetal heartbeat decelerated to 60 bpm. After fundal pushing for some minutes, a female baby weighing 2130 g was delivered at 11:54 PM with a pediatrician on standby. Apgar scores were 7 (0 minute), 9 (5 minutes), and 10 (10 minutes). The placenta weighed 870 g and was delivered 5 minutes later, and VCI was discovered.
Her postpartum course was uncomplicated and both the patient and infant were discharged 3 days later.
A pregnant woman with umbilical prolapse, VCI, and a fetal vertex presentation can successfully deliver a baby through the vagina. Factors contributing to the success of the reported vaginal delivery might have been a small fetus, multipara status, and immediate management.
我们报告一例罕见病例，一名患有脐带脱垂、帆状脐带附着（VCI）且胎儿为头先露的孕妇成功完成阴道分娩。
一名31岁孕妇，孕6产4流1，未进行定期产前检查，在妊娠37周零3天时就诊。她有规律的宫缩痛和见红。
分娩时脐带脱垂，产后发现帆状脐带附着。
晚上11点20分经阴道检查发现宫颈已完全扩张。30分钟后，行人工破膜，在阴道内触及一条约10厘米长的明显脱垂脐带。胎儿心率降至60次/分。经数分钟的宫底按压后，一名体重2130克的女婴于晚上11点54分在有儿科医生待命的情况下娩出。阿氏评分分别为7分（0分钟）、9分（5分钟）和10分（10分钟）。胎盘重870克，5分钟后娩出，随后发现帆状脐带附着。
她产后恢复过程顺利，患者和婴儿在3天后出院。
一名患有脐带脱垂、帆状脐带附着且胎儿为头先露的孕妇可以通过阴道成功分娩。此次阴道分娩成功的因素可能包括胎儿较小、经产妇状态以及及时的处理。
