A multiparous woman (VDRL-negative, Rh-positive) was admitted in labor to an Air Force hospital at an estimated 38 weeks of pregnancy. A 1,928-gm, male infant was delivered precipitously. Immediately after expulsion, the infant was noted to be extremely pale and weak, although it breathed and cried promptly. A second male infant, of similar weight, was then delivered spontaneously and appeared normal.
The contrast in appearance between the two infants was striking. The first infant, receiving oxygen by mask, had obvious pallor without cyanosis or respiratory retractions. The respirations were irregular and gasping, the cry feeble. Neither peripheral nor precordial pulses of the first baby were palpable, but a faint, rapid heart beat was heard on auscultation.
The second infant was pink, active, and crying vigorously, even without the administration of oxygen. Neither baby had edema, a palpable spleen or liver.
A diagnosis of posthemorrhagic shock in the first infant was made.
Soon thereafter, a single placenta with velamentous insertions of the cords (Fig. 1) at each side was delivered. The umbilical vessels of one cord were totally avulsed at the velamentous insertion, except for a thread-like strand which later separated in handling.
Thirty milliliters of dextran were injected immediately into a cutaneous vein of the first infant, approximately 15 minutes after delivery. The baby immediately became much more vigorous and developed a discernible pulse. Further improvement occurred when 30 ml of Group-O, Rh-negative blood was injected, approximately 30 minutes later.
The first hemoglobin determination, deferred until 20 hours of age to avoid unnecessary handling was 10.6 gm/100 ml in the first infant, as compared to 16 gm/100 ml in the second.
Further replacement and comparative studies are shown in Figure 2. Neither infant developed icterus during the stay in the nursery. Both infants received a transfusion toward the end of the hospitalization. Blood studies and development of both infants were normal at 2 and 5 months, respectively.
- Received November 28, 1958.
- Copyright © 1959 by the American Academy of Pediatrics