Umbilical cord vascular thrombosis

1. SCBU case report
M. BABY

2. History
● A 3min old female term neonates rushed in with APGAR score of 3
● Neonates body was covered in meconium, resuscitation was commenced
immediately
● Spot at presentation was 70%.
● Airway was cleared, meconium sunctioned out and AMBU bagging was
commenced
● At 5th minutes of life APGAR became 6

3. Mothers history
● Mother had EMCS on account of obstructed labour
● Mother is a 23years old Housewife, unsure of her LMP, however uss put
gestation at 38weeks
● Antenatal history were essentially normal
● Not a known DM, or HTNsive

4. Exams finding
● She was conscious, pink afebrile anicteric SpO2 88%
● Portswine stained, multiple salmon patches covering the body with exfoliating
skin
● Umbilical cord was found thrombosed : blood filled upto about 7cm, cord is
distended and caliber of vessels seen were abnormally large in diameter
● Other exams were essentially normal

7. Available results
● PCV46% RBS 5.1mmol/l

8. Diagnosis
● Respiratory distress of newborn 2 to meconium aspiration
● Mild perinatal asphyxia
● Umbilical cord thrombosis

9. Management
● IV fluids
● Antibiotics
● Vitamin K

10. 4th hour of life
● Neonates became very pale and breathless
● Repeated PCV was 46%
● Patient was planned to be transfused

11. 7th Hour of life
● She was transfused with sedimented blood at 15ml/kg
● SpO2 after transfusion was 64% on oxygen

12. 9th hr of life
● Baby was found gasping CPR commenced
● Patients died at 12:19am

13. Discussion
The findings of thrombosed umbilical cord should have changed the outcome
It is a rare complication of pregnancy and delivery
We found few cases reported in journals
Incidence of umbilical cord thrombosis is 1;1500
It is strongly associated with fetal demise and perinatal death

14. Etiology
Cause is unknown
2 reported cases from St Joseph healthcare ontario Canada found meconium
present in amniotic fluid of the 2 babies raising possibility of vascular insult as a
cause

15. Associations
Cases found online in journals were associated with
portal vein thrombosis
Severe protein S deficiency
Intraarterial ischeamic stroke.

16. Management
Management remains unsolved puzzle to clinicians globally
Despite high mortality there are still survivors especially those that were start early
on low molecular weight heparin at birth
Good outcome depends on
Early detection
Fetal monitoring
Preemptive delivery
Prompt intervention

17. Conclusion
Umbilical cord thrombosis is a rare event that can lead to neonatal death. When a
baby is delivered with thrombus in the umbilical cord, it may be prudent to
investigate for portal vein thrombosis. Low molecular weight heparin could be
tried. End-organ damage should be considered, and a thrombophilia screen is
also warranted.

18. Thanks for listening