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Peripheral ischaemia and gangrene presenting at birth

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Abstract

The aetiology of non-iatrogenic causes of peripheral ischaemia and gangrene presenting either at birth or within a few hours of delivery is unknown in the majority of 56 confirmed cases. In this review of 47 cases occurring since 1941 the aetiology was clear in only 6, four due to compression by the encircling umbilical cord. There was no clear association with gestational age, birth weight, maternal age or type of delivery. Seven were infants of poorly controlled diabetic mothers and these may constitute a subgroup due to altered haemostatic mechanisms. Pregnancy hypertension was an association in 7 cases, oligohydramnios in 6. There is only limited support for birth trauma, sepsis, and thrombo-emboli from the ductus arteriosus as causes. There is indirect evidence that thrombo-emboli can migrate from the placental bed to the fetus. In recent years death from this condition has been rare with surgical thrombectomy increasingly successful in late presenting cases. When gangrene is established at birth surgical amputation, autoamputation, or some loss of function is usual. Peripheral ischaemic insults presenting at birth may be part of a wider spectrum of disorders, both prenatal and perinatal, attributable to occlusive vascular disruption.

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Abbreviations

DA:

ductus arteriosus

IDMs:

infants of diabetic mothers

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Authors and Affiliations

  1. Department of Paediatrics, The Nazareth Hospital, P.O.Box 11, 16100, Nazareth, Israel

    P. D. Turnpenny

  2. Hand Unit, Rambam Medical Centre, Haifa, Israel

    S. Stahl

  3. The Nazareth Hospital, Nazareth, Israel

    D. Bowers (Senior Physiotherapist)

  4. Department of Public Health Medicine, Conventry Health Authority, Coventry, UK

    P. Bingham

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  1. P. D. Turnpenny
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  2. S. Stahl
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  3. D. Bowers
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  4. P. Bingham
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Turnpenny, P.D., Stahl, S., Bowers, D. et al. Peripheral ischaemia and gangrene presenting at birth. Eur J Pediatr 151, 550–554 (1992). https://doi.org/10.1007/BF01957717

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  • DOI: https://doi.org/10.1007/BF01957717

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