title: [Severe neonatal blood loss due to umbilical cord rupture in an underwater birth].
abstract: BACKGROUND
  We present the case of an intrapartum umbilical cord rupture in an underwater birth with severe neonatal blood loss.
  
  
  METHODS
  A healthy 25-year-old gravida I with an uneventful pregnancy had an underwater birth. A completed rupture of the umbilical cord was diagnosed immediately after the newborn surfaced from the water and was laid on the mother's chest. The newborn suffered from severe haemorrhage with bradycardia and respiratory distress. It was immediately resuscitated by the neonatologist. Intravenous donation of volume and red blood cell transfusion could stabilise the vital parameters. The newborn was discharged in a state of well-being 6 days postnatally.
  
  
  CONCLUSIONS
  Cases of umbilical cord rupture are reported in relationship to land and water births. Common causes of a cord rupture include haematoma of the cord vessels, trauma from an operative vaginal delivery, funisitis with localised cord necrosis, velamentous cord insertions, tumours of the umbilical cord and a short umbilical cord. A suspicious foetal heart rate might be absent. In the case of a water birth complications bear serious consequences. Proper team work between obstetricians and neonatologists is essential.
  
  
  CONCLUSIONS
  Although water birth is restricted to low risk patients, unforeseen complications may occur. Because of the special situation in an underwater birth complications may be diagnosed late and their management will be more difficult. Obstetricians should be aware of this risk.
authors.affiliation: Abteilung für Gynäkologie und Geburtshilfe des Universitätsspitals Basel, Schweiz. kkalf@uhbs.ch
authors.forename: K
authors.initials: K
authors.lastname: Kalf
authors.forename: L
authors.initials: L
authors.lastname: Hochstrasser
authors.forename: O
authors.initials: O
authors.lastname: Lapaire
authors.forename: L
authors.initials: L
authors.lastname: Hegi
authors.forename: J
authors.initials: J
authors.lastname: Benzing
authors.forename: I
authors.initials: I
authors.lastname: Hösli
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D007101:Immersion / Q000009:adverse effects*; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012421:Rupture; D014470:Umbilical Cord / Q000293:injuries* / Q000473:pathology