International Journal of Clinical Case Reports 2017, Vol.7, No.15, 62-66
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This vicious cord implantation, which instead of being inserted into the placenta, is inserted on the membranes
and its vascular ramifications, not protected by Wharton's jelly, bind the placenta "bare" thereby in addition to the
risks potential asphyxia by compression or fetal hemorrhage that may occur during pregnancy (Kazadi, 1991).
The severity of this insertion resides in the occurrence of fetal haemorrhage by vascular shredding during the
spontaneous or artificial rupture of the membranes (Kazadi, 1991; Heckel et al., 1993; Régis et al., 2006). This
hemorrhagic accident complicates one case for 50
velamentous
insertions.
It is also reported, but in an exceptional way, that this haemorrhage may be secondary to preavia pathways of the
chorionic vessels outside any velamentous insertion. This aberrant path is most often linked to an aberrant
cotyledon or to a very eccentric insertion of the cord. In our observation, haemorrhage was secondary to a
velamentous insertion of the cord on a low inserted placenta type I of Bessis.
The clinical picture includes a typical symptomatic triad (Kazadi, 1991; Heckel et al., 1993; Régis et al., 2006;
Aissi et al., 2013):
1- Painless genital hemorrhage, often important, concomitant with rupture of the membranes and which persists
after the amniotomy.
2- Acute and immediate fetal suffering, rapidly unfavorable evolution towards fetal death by exsanguination in
utero.
3- A constant maternal general condition.
Such symptomatology should prompt Benckiser's hemorrhage diagnosis and indicate immediate fetal extraction
(Chmait et al., 2010). However, this diagnosis may be more delicate because of the clinical polymorphism of this
disease: fetal haemorrhage may be delayed compared to rupture of membranes and occurs only late in labor when
the vascular wound occurs during enlargement of the membrane orifice by the fetal presentation (Aissi et al.,
2013), it can be broken during iatrogenic maneuvers such as the setting of scalp electrode. This delay between the
rupture of the membranes and the occurrence of hemorrhage can be extended from a few minutes to several hours.
Fetal hemorrhage may also be absent or stopped by compression of the vascular wound by fetal presentation or
thrombosis, under these conditions fetal distress may be absent and bleeding is labeled as isolated but severity Of
this form is the risk of recurrence of the haemorrhage with a very reserved fetal prognosis.
The rupture of these preavia vessels can occur with intact membranes, and cause an in utero or externalized
haemorrhage, so the diagnosis is extremely difficult. Its etiopathogenesis is imprecise (histological lesion of
endarteritis, rupture of an umbilical vein of a very short cord).
Finally, there are completely asymptomatic forms when the rupture spares the vascular ramifications and the
presentation progresses without incident while repressing these vascular branches. In these cases, the diagnosis is
retrospectively examined for delivery (Aissi et al., 2013). In our observation the clinical picture was complete of
which made the diagnosis easy to take care in time.
The differential diagnosis is that of any hemorrhage in the third trimester. It arises with:
1- The placenta preavia: The association of these two pathologies is frequent. The fundamental element of the
diagnosis is that the haemorrhage of the placenta preavia is anterior to the rupture of the membranes and can cease
shortly afterwards, whereas the hemorrhage of Benckiser succeeds it.
2- The retro placental hematoma: The haemorrhage is made of minimal black blood, anterior to the rupture of the
membranes with alteration of the maternal general state; often in the context of pre-eclampsia.
3- Uterine rupture: Fetal suffering and haemorrhage are common for both diseases, but the context (scar or
multiparity uterus) associated with an alteration of the patient's general condition makes it possible to correct the
diagnosis.
4- Low genital haemorrhages: They do not affect the fetus. Their diagnosis is based on simple speculum
examination.
