European Journal of Obstetrics & Gynecology and Reproductive Biology
ReviewA case of umbilical cord hemangioma: Doppler studies and review of the literature
Introduction
The true tumors of the umbilical cord consist of hemangiomas and teratomas [1]; the former are by far the more common, and the only one that has been identified prenatally thus far [2]. Hemangiomas have been associated with congenital anomalies, increased maternal serum alpha fetoprotein (MS-AFP), and increased perinatal mortality, in specific intrauterine deaths [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Nevertheless, due to their rarity, with less than 50 cases being reported in the literature, their clinical importance remains uncertain [2], [3], [7], [15], [16].
Impaired umbilical circulation is considered as the predisposing factor for fetal demise [6], [7], [9], [10], [11], [14], and several authors speculated that Doppler flow studies of umbilical vessels can be helpful in managing these cases [10], [17]. However, to our knowledge, no reports with Doppler studies of each umbilical vessel separately have been conducted to show differences in flow resistance, and to confirm possible risks [10], [13], [17].
We present a case of a prenatally diagnosed umbilical cord haemangioma, in an otherwise uncomplicated pregnancy. Close follow up was carried out, with sequential scans to monitor the size and the morphology of the tumor. Furthermore, the umbilical cord circulation was monitored with Doppler flow studies of each umbilical vessel separately, with special interest in the part within the tumor (intra-tumoral). We present our data with review of the relevant literature.
Section snippets
Case report
A 27-year-old woman, gravida 2, para 1, with an otherwise uncomplicated pregnancy was referred to our Department for a routine anomaly scan, at 22 weeks. Her first pregnancy was uneventful, and ended in a vaginal delivery of a healthy female infant weighing 2970 g. Both parents had an unremarkable medical and family history. The first trimester scan was normal and the second trimester biochemical markers were normal as well. The MS-AFP was 68.9 IU/l (1.38 MoM).
The ultrasound machine used was a
Prevalence
The reports of umbilical cord hemangiomas in the English literature are scarce. We were able to identify 35 cases (including our own) [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], which are summarized (Table 2), and discussed herein. Fourteen of them were detected after delivery [3], [4], [5], [6], [7], [11], [17], [18], [19], [20], [21], either as a coincidental
Conclusion
Hemangiomas are extremely rare benign tumors of the umbilical cord. They are associated with increased MS-AFP and hydramnios, while a predisposition towards female gender might exist. A relationship with increased perinatal mortality does exist, although its power remains to be defined. Impaired umbilical circulation seems to be the contributing factor to fetal compromise. Close follow up is mandatory with Doppler flow studies of all umbilical vessels involved, with special attention to the
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