Absent end diastolic flow in umbilical artery and umbilical cord thrombosis at term of pregnancy.
BACKGROUND
Meconium staining of the fetus and placenta is associated with increased neonatal mortality and asphyxia. Very often it is unclear whether the discharge of meconium is a cause or an effect of fetal distress. In the available literature there are no large epidemiological studies of pregnancy outcome with meconium-related lesions, even though this could be useful to improve our state of knowledge on this topic.


METHODS
A case of umbilical cord vascular necrosis is described. A severely asphyxiated infant was delivered at 39 weeks' gestation by cesarean section due to alarming results of fetal heart rate monitoring and rupture of membranes with meconium-stained amniotic fluid. There was no meconium aspiration. We report a review of 15 similar cases. In the whole series, a linkage between umbilical cord vascular necrosis and evidence of remote meconium discharge always seems to be detectable. The pathophysiological mechanism is unknown.


CONCLUSIONS
It is still not clear why only a tiny percentage of cases with meconium-stained amniotic fluid develops umbilical cord lesions and poor pregnancy outcome. Further investigations are needed to explain why some meconium-stained newborns suffer severe neurological and other damage even without meconium aspiration.
Larciprete
Giovanni
G
A. Fa. R. Associazione Fatebenefratelli per la Ricera, Ospedale Fatebenefratelli Isola Tiberina, Rome, Italy.
di Pierro
Giuseppe
G
Giacomello
Francesco
F
Santacroce
Criselda
C
Valensise
Herbert
H
Arduini
Domenico
D
D000328:Adult; D003971:Diastole; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008470:Meconium; D011247:Pregnancy; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014469:Umbilical Arteries / Q000473:pathology / Q000503:physiopathology; D014471:Umbilical Veins / Q000473:pathology / Q000503:physiopathology