Laceration of umbilical cord vessels secondary to amniocentesis

Amniocentesis has been established as a valuable diagnostic tool in the management of high-risk pregnancies. Although infrequent, various fetal complications have been reported. A serious and potentially fatal complication is laceration of the umbilical cord vessels. Three cases are presented to illustrate this complication and a scheme is proposed for management when bloody fluid is obtained at the time of amniocentesis. If the bleeding is of fetal origin, and the fetus is at or near term, immediate delivery should be considered. Expectant management should be considered only in the premature fetus when continuous fetal heart rate monitoring is possible and no bradycardia is encountered. Induction and vaginal delivery should be attempted only in the absence of a bradycardia and if the patient is able to be continuously monitored. Postamniocentesis fetal bradycardia should prompt immediate delivery via cesarean section regardless of gestational age. Any newborn whose uterine existence has been complicated by a traumatic or bloody tap should have an immediate hematocrit determination at birth.