Necrotizing funisitis and calcification of umbilical vein: case report and review
Wendi Wang1, Miao Zhang2, Liyun Gong3
1Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, Beijing, 100026, China.
Background:
Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF is characterized by yellow-white bands running parallel to the umbilical blood vessels. These bands consist of inflammatory cells, necrotic debris, and calcium deposits. Calcification is visible in ultrasonography, which makes it possible to suspect NF when umbilical vascular wall calcification is detected by prenatal ultrasonography.
Case Presentation:
Ultrasonography revealed calcification of the umbilical venous wall in an expectant 31-year-old woman who was gravida 1, para 0. The woman required emergency cesarean section because of fetal distress and suspected umbilical cord torsion at 31 weeks gestation. The root of the umbilical cord was quite fragile and broke during the operation. The pathological results on the placenta showed histologic chorioamnionitis and NF. The infant was diagnosed to have neonatal sepsis and acidosis after delivery but was discharged without severe complications after a one-month hospitalization that included antibiotic and supportive therapy.
Conclusion:
NF is a rare and severe inflammation of the umbilical cord. Umbilical vascular wall calcification discovered in prenatal ultrasonography is diagnostically helpful.
Insights
Necrotising funisitis (NF), a severe umbilical cord inflammation, can be suspected via prenatal ultrasound detecting umbilical vascular wall calcification. Early detection aids in managing potential fetal adverse outcomes associated with this rare condition.
Area of Science:
- Perinatology
- Obstetrics
- Fetal Medicine
Background:
- Necrotising funisitis (NF) is a rare, chronic stage of funisitis, characterized by umbilical cord inflammation and associated with adverse fetal outcomes.
- Histologically, NF presents as yellow-white bands containing inflammatory cells, necrotic debris, and calcium deposits along umbilical blood vessels.
- Prenatal ultrasonography can reveal calcification of the umbilical vascular wall, suggesting the presence of NF.
Observation:
- A 31-year-old pregnant woman presented with ultrasonographic evidence of umbilical venous wall calcification.
- The patient underwent emergency cesarean section at 31 weeks gestation due to fetal distress and suspected umbilical cord torsion.
- Intraoperative findings included a fragile umbilical cord that fractured during delivery; placental pathology confirmed histologic chorioamnionitis and NF.
Findings:
- The infant was diagnosed with neonatal sepsis and acidosis post-delivery.
- Despite initial complications, the infant recovered after a month of hospitalization with antibiotic and supportive care.
- Prenatal detection of umbilical vascular wall calcification was a key indicator for suspecting NF.
Implications:
- Prenatal ultrasonographic detection of umbilical vascular wall calcification is a valuable diagnostic clue for necrotising funisitis.
- Prompt identification of NF can guide obstetric management and potentially mitigate severe fetal complications.
- This case highlights the importance of recognizing sonographic markers for rare but serious placental and umbilical cord pathologies.
