[Benckiser's hemorrhage. 2 case reports and a review of the literature]

Benckiser's haemorrhage is a pure foetal bleeding due to rupture of one or several umbilical vessels located within the presentation area and usually associated with velamentous insertion of the cord. The frequency of this accident has been estimated at 1:2000 to 1:5000 deliveries. The clinical picture consists of haemorrhage occurring during rupture of the membranes and rapid foetal suffering responsible for foetal death from acute exsanguination in 75 to 100% of the cases. The maternal prognosis is excellent. Since the first clinical description, in 1801, less than 200 cases have been published. Many atypical forms delaying the diagnosis have been noted. The authors report 2 lethal cases with misleading clinical presentations. With intact membranes, prevention rests on the diagnosis of vasa praevia made by vaginal palpation, amnioscopy or even ultrasonography combined with colour-coded doppler velocimetry. With ruptured membranes, the diagnosis is usually retrospective and bases on examination of the secundines. Testing foetal haemoglobin in the vaginal blood can be very useful in the absence of acute foetal suffering. The management of this haemorrhage is discussed.