Department of Forensic Evidence Science, School of Forensic Medicine, Southern Medical University, Guangzhou, China.
Guangdong Public Security Department, Guangzhou, China.
Leg Med (Tokyo). 2024 Sep;70:102493. doi: 10.1016/j.legalmed.2024.102493. Epub 2024 Jul 14.
Fetal umbilical cord hematoma has a low incidence but high mortality, and its cause during delivery is often unclear. We report an autopsy case in which it was concluded that umbilical cord hematoma resulted from fetal movements during childbirth.
A 27-year-old primigravida at 39 + 2 weeks gestation with normal antenatal visits suffered a fetal heart rate decrease during active labor. Bedside ultrasound revealed fetal death in utero 22 min later. Forensic pathologists found that the umbilical vessels were torn and bleeding on almost the same plane, and the hematoma compressed both umbilical arteries, which is the cause of fetal stillness in utero. A total of 32 cases were reported, including 6 umbilical cord ruptures and 26 umbilical cord hematomas. The cause of hematoma was unknown in 77 % of cases, while dysplasia was present in 56.25 % of umbilical cords.
This case indicates that fetal movements may cause umbilical cord vessel injury, particularly when oxytocin is used to induce labor. When fetal heart sounds decrease for no apparent reason, the possibility of cord injury should be considered, and cesarean delivery should be performed as soon as possible. Therefore, rigorous fetal heart tracing during active delivery is necessary.
胎儿脐带血肿的发病率较低，但死亡率较高，其分娩时的病因往往不清楚。我们报告了一例尸检病例，结论为脐带血肿是由于分娩过程中的胎儿运动引起的。
一名 27 岁初产妇，孕 39+2 周，产前检查正常，活跃期胎心减速。床边超声显示胎儿在 22 分钟后死于宫内。法医病理学家发现，脐带血管几乎在同一平面撕裂出血，血肿压迫了两条脐动脉，这是导致胎儿宫内静止的原因。共报告了 32 例，包括 6 例脐带破裂和 26 例脐带血肿。77%的病例血肿原因不明，56.25%的脐带存在发育不良。
本病例表明，胎儿运动可能导致脐带血管损伤，特别是在使用催产素引产时。当胎心音无缘无故下降时，应考虑脐带损伤的可能性，并尽快行剖宫产术。因此，活跃分娩时需要严格进行胎心监护。
