Cord hematomas are rare and generally follow rupture of an umbilical vessel, usually the vein, and bleeding into the Wharton jelly. Hematomas have been associated with abnormal cord length, umbilical vessel aneurysm, trauma, entanglement, umbilical vessel venipuncture, and funisitis (Gualandri, 2008). Most are identiied postpartum, but hematomas are recognized so no graphically as hypoechoic masses that lack blood low (Chou, 2003). Sequelae include stillbirth or intrapartum abnormal fetal heart rate pattern (Abraham, 2015; Barbati, 2009; Sepulveda, 2005; Towers, 2009).
Umbilical cord vessel thromboses are rare in utero events and seldom diagnosed antepartum. Approximately 70 percent are venous, 20 percent are venous and arterial, and 10 percent are arterial thromboses (Heifetz, 1988). hese all have high associated rates of stillbirth, fetal-growth restriction, and intrapartum fetal distress (Minakami, 2001; Sato, 2006; Shilling, 2014). If these are identiied antepartum as hypoechoic masses without blood low, data from case reports support consideration of prompt delivery if of viable age (Kanenishi, 2013).
n umbilical vein varix can complicate either the intraamnionic or fetal intraabdominal portion of the umbilical vein. So no graphically and complemented by color Doppler, rare intraamnionic varices show cystic dilatation of the umbilical vein that is contiguous with a normal-caliber portion. Of complications, an intraamnionic varix may compress an adjacent umbilical artery or can rupture or thrombose. In cases without these, White and colleagues (1994) recommend fetal surveillance and delivery once fetal maturity is confirmed. However, data are limited and derived from case reports.
he rare umbilical artey aneuysm is caused by congenital thinning of the vessel wall with diminished support from Wharton jelly. Indeed, most form at or near the cord placental insertion site, where this support is absent. These are associated with single umbilical artery, trisomy 18, amnionic luid volume extremes, fetal-growth restriction, and stillbirth (Hill, 2010; Vyas, 2016). At least theoretically, these aneurysms could cause fetal compromise and death by compression of the umbilical vein. These aneurysms may appear sonographically as a cyst with a hyperechoic rim. Within the aneurysm, color low and spectral Doppler interrogation demonstrate either lowvelocity or turbulent nonpulsatile flow (Olog, 2011; Sepulveda, 2003; Shen, 2007b). Although not codified, management may include fetal karyotyping, antenatal fetal surveillance, and early delivery to prevent stillbirth (Doehrman, 2014).
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