Umbilical cord

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

Revised: 28 August 2015, last major update August 2015

Copyright: (c) 2002-2015,, Inc.

PubMed Search: Hematoma [title] umbilical cord
Definition / General
  • The extravasation of blood from an umbilical vessel that subsequently accumulates in Wharton's 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
  • Fetal heart tracings can show decreased variability and an absence of accelerations (J Perinatol 2009;29:517)
  • Radiology images
  • Ultrasound can reveal cord expansion with a heteroechoic to hyperechoic mass or discordant umbilical artery Doppler waveforms
  • Case Reports
  • Spontaneous umbilical cord hematoma (Am J Forensic Med Pathol 2008;29:185)
  • Fetal death due to umbilical cord hematoma (J Matern Fetal Neonatal Med 2005;18:387)
  • Umbilical cord hematoma secondary to in utero intravascular transfusion for Rh isoimmunization (Fetal Ther 1987;2:65)
  • Treatment
  • Induction of delivery can be undertaken if fetal compromise is present
  • Gross Description
    Missing Image

    Hematoma of umbilical cord

    Missing Image

    Rupture of umbilical vessels

    Micro Description
  • Nonspecific and variable hemorrhage involving Wharton's jelly
  • Less commonly, evidence of vascular disruption, cystic changes, or aneurysmal dilatation