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Velamentous cord insertion ruptured during labour leading to acute fetal blood loss
  1. Takeshi Nagao,
  2. Erisa Kuriyama,
  3. Ami Sato and
  4. Michiko Yamanaka
  1. Integrated Women's Health, St Luke's International Hospital, Tokyo, Japan
  1. Correspondence to Dr Takeshi Nagao; takeshi.n.900113{at}


Umbilical cord rupture (UCR) in utero is a very rare and critical emergency that can cause fetal death within minutes. A 38-year-old nulliparous woman was admitted at 39 weeks in labour. Sudden watery vaginal discharge and bleeding with a rapid drop in the fetal heart rate to 60 beats/min necessitated an emergency caesarean section. A male infant weighing 2632 g was delivered 21 min after the onset of bradycardia; Apgar scores were 0 and 1 at 1 and 5 min, respectively. He was extremely pale; the umbilical arterial blood pH was 6.89 and haemoglobin was 9.0 g/dL. The umbilical cord had a velamentous insertion and was lacerated, with haemorrhage in the outer layer of an umbilical artery close to the placental end. The presentation was typical of UCR: vaginal bleeding following the rupture of membranes. Prompt diagnosis of UCR and termination of pregnancy are essential for fetal survival.

  • emergency medicine
  • pregnancy

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  • Contributors TN, EK and AS treated the patient. TN wrote the manuscript. MY provided advice and proofread the manuscript. All the authors approved the final version of this case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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