Umbilical Cord around the Fetal Leg Co-Existing with Type IV Placenta Previa in a Primigravida with Successful Neonatal Outcome in a Low-Income Setting: A Case Report

Cord entanglement is defined as an umbilical cord that encircles the fetal body, neck, or extremities with overall reported prevalence of 30 %. Its effects on perinatal outcomes is controversial and management is very challenging in low and middleincome settings especially when it co-exists with bleeding Type IV placenta previa. A 19-year-old undergraduate, unbooked primigravida who was unsure of her last menstrual period, presented with sudden vaginal bleeding and collapse. The vaginal bleeding was recurrent, of moderate volume and the current episode started about one hour prior to presentation. She had no antenatal care. On examination, she was pale and in shock. Her abdomen was enlarged and the symphysio-fundal height was 34 cm; there was a singleton fetus in longitudinal lie and cephalic presentation, the fetal heart rate was 166 beats per minute. There was active vaginal bleeding. Bedside 2D Ultrasound revealed Type IV placenta previa at 34 weeks and 6 days of gestation. She was promptly resuscitated and an informed consent obtained for an emergency caesarean section for antepartum haemorrhage due to major degree placenta previa. She had a live female infant weighing 2.2 kg with Apgar scores of 4 and 7 at the 1st and 5th minutes respectively with umbilical cord around the right leg. The neonatal period was satisfactory. The case involved an umbilical cord around the leg only diagnosed intrapartum with co-existing bleeding type IV placenta previa, which could have led to severe neonatal and maternal complications. This report reveals the importance of antenatal care, early diagnosis and prompt management of obstetric patients to prevent morbidity and mortality.