Acute Fetal Hemorrhagic Shock Due to Umbilical Cord Rupture in a Term Pregnancy With Single Umbilical Artery and Velamentous Cord Insertion: A Case Report and Literature Review.

Umbilical cord rupture, though rare, is a severe obstetric complication with significant implications for neonatal morbidity and mortality. We present the case of a 38-year-old primiparous female diagnosed with a single umbilical artery (SUA) and velamentous cord insertion (VCI) in late pregnancy. At 40 weeks of gestation, during labor induction, the patient suddenly experienced massive vaginal bleeding and fetal bradycardia, necessitating an emergency cesarean section. Postoperatively, it was confirmed that the umbilical cord had ruptured. The neonate required immediate and intensive resuscitation, including blood transfusion and therapeutic hypothermia. Remarkably, despite the critical initial condition, the neonate exhibited no neurological deficits and was discharged in stable condition on the 27th day. The presence of SUA and VCI likely increased the vulnerability of the umbilical cord, predisposing it to rupture. This case emphasizes the importance of prenatal ultrasound in detecting umbilical cord abnormalities such as SUA and VCI. The early detection of these abnormalities allows for proactive management, including closer monitoring and timely surgical intervention, which are crucial for optimizing neonatal outcomes. This report provides valuable insights into the pathophysiology and management of umbilical cord rupture.

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Human subjects: Consent was obtained or waived by all participants in this study. The Shiga University of Medical Science Research Ethics Committee issued approval R2022-116. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.