Fetal Anaemia following preterm en caul delivery with velamentous cord insertion

• Main Authors: Mohd Nor, Nurul Yaqin, Ismail, Hamizah, Ismail, Nurul Jannah
• Format: Article
• Language: English
• Published: Malaysian Medical Association 2021
• Subjects: RG Gynecology and obstetrics
• Online Access: http://irep.iium.edu.my/98402/1/98402_Fetal%20Anaemia%20following%20preterm%20en%20caul%20delivery.pdf; http://irep.iium.edu.my/98402/; http://www.e-mjm.org/2021/v76s3/A-91-92.pdf

Introduction: En caul delivery is defined as delivery of fetus in the sac with fully intact membrane. It was recommended in preterm in estimated fetal weight < 1,500 gram during Caesarean section to reduce risk of fetal injury caused by 'hug-me-tight' uterine contraction and surgeon hands. However, in some cases en caul can be dangerous due to fetal hemorrhage. Objectives : This case series describes our experience in IIUM performing en caul delivery in preterm birth and its immediate sequelae with regards to fetal anemia and birth trauma. Methods: Case Series Results: Two were born with intact membrane and one in partial en caul. One reported to have severe anemia and another two without neonatal anemia. None of the babies had birth trauma Conclusion : En caul delivery can be beneficial in properly selected cases and application of good surgical technique resulting in less birth injury and good fetal outcome. From our experience to make this delivery technique safe and beneficial for extreme preterm fetus, we strongly suggest that the cord insertion need to be identified prior caesarean section, in case of central cord insertion it is safe to deliver en caul. However, if velamentous or abnormally loclized cord insertion was identified, immediate clamping of the cord can reduce the complication of fetal hemorrhage and anemia.