Global InformationVelamentous cord insertion information
| Velamentous cord insertion | |
|---|---|
| Other names | Velamentous Placenta |
 | |
| Normal umbilical cord insertion and velamentous umbilical cord insertion in pregnancy, with and without vasa previa. | |
| Specialty | Obstetrics  |
| Symptoms | Blood vessel compression,[1][2] decrease in blood supply to the fetus,[2][3] impaired growth and development of the fetus.[4][5] |
| Risk factors | Multiple gestation,[1][2][6][7][8] placental anomalies [9] previous pregnancy with abnormal cord insertion[2] |
| Diagnostic method | Abdominal ultrasound[3][4] |
| Treatment | Caesarean section[7] |
| Frequency | 0.1%-1.8% of pregnancies[6] |
Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor.[10] In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta.[1][11] Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.[1][9]
The exact cause of velamentous cord insertion is unknown, although risk factors include nulliparity,[2][6] the use of assisted reproductive technology,[6][12] maternal obesity,[6][7] and pregnancy with other placental anomalies.[9] Velamentous cord insertion is often diagnosed using an abdominal ultrasound.[3][4] This is most successful in the second trimester,[13] however Color Doppler ultrasound[14] or transvaginal ultrasound[15] can be used in difficult cases, such as when the placenta is located posteriorly. If the woman is diagnosed with velamentous cord insertion, the pregnancy is closely monitored, especially as velamentous cord insertion is a strong risk factor for vasa previa, where the exposed vessels cross the cervix and are at high risk of rupture during membrane rupture in early labor.[9] Management strategies for velamentous cord insertion also involve determining the presence of vasa previa.[16] Velamentous cord insertion impacts fetal development during pregnancy by impairing the development of the placenta[2] and modifying the efficiency of placental function.[17] This can manifest in a range of adverse perinatal outcomes, such as fetal growth restriction,[4][5] placental abruption,[3][6][16][18] abnormal fetal heart rate patterns,[3][10][19] and fetal death.[6][7][9] Velamentous cord insertion affects between 0.1%-1.8% of pregnancies,[6] though its incidence increases ten-fold in multiple pregnancies.[1][10]
- ^ a b c d e Ismail K, Hannigan A, ODonoghue K, Cotter A (2017). "Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis". Systematic Reviews. 6 (1): 242. doi:10.1186/s13643-017-0641-1. PMC 5718132. PMID 29208042.
- ^ a b c d e f Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S (2013). "Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies". PLOS ONE. 8 (7): e70380. Bibcode:2013PLoSO...870380E. doi:10.1371/journal.pone.0070380. PMC 3728211. PMID 23936197.
- ^ a b c d e Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T (2006). "Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications". Taiwanese Journal of Obstetrics and Gynecology. 45 (1): 21–25. doi:10.1016/S1028-4559(09)60185-6. PMID 17272203.
- ^ a b c d Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J (2003). "Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study". Ultrasound in Obstetrics and Gynecology. 21 (6): 564–569. doi:10.1002/uog.132. PMID 12808673. S2CID 1788491.
- ^ a b Eddleman K, Lockwood C, Berkowitz G, Lapinski R, Berkowitz R (1992). "Clinical Significance and Sonographic Diagnosis of Velamentous Umbilical Cord Insertion". American Journal of Perinatology. 9 (2): 123–126. doi:10.1055/s-2007-994684. PMID 1590867. S2CID 39286973.
- ^ a b c d e f g h Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S (2012). "Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study". European Journal of Obstetrics & Gynecology and Reproductive Biology. 165 (2): 231–234. doi:10.1016/j.ejogrb.2012.08.021. PMID 22944380.
- ^ a b c d Wiedaseck S, Monchek R (2014). "Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management". Journal of Midwifery & Women's Health. 59 (3): 328–335. doi:10.1111/jmwh.12189. PMID 24751147.
- ^ Furuya S, Kubonoya K, Kubonaya K (2014). "Prevalence of velamentous and marginal umbilical cord insertions; a comparison of term singleton ART and non-ART pregnancies". Fertility and Sterility. 102 (3): e313. doi:10.1016/j.fertnstert.2014.07.1063.
- ^ a b c d e Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C (2016). "Velamentous insertion of umbilical cord with vasa praevia: case series and literature review". Journal of Medicine and Life. 9 (2): 126–129. PMC 4863500. PMID 27453740.
- ^ a b c Sinkin J, Craig W, Jones M, Pinette M, Wax J (2018). "Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies". Journal of Ultrasound in Medicine. 37 (2): 471–718. doi:10.1002/jum.14357. PMID 28850682. S2CID 26888548.
- ^ Paavonen J, Jouttunpää K, Kangasluoma P, Aro P, Heinonen P (1984). "Velamentous insertion of the umbilical cord and vasa previa". International Journal of Gynecology & Obstetrics. 22 (3): 207–211. doi:10.1016/0020-7292(84)90007-9. PMID 6148278. S2CID 23409481.
- ^ Delbaere I, Goetgeluk S, Derom C, De Bacquer D, De Sutter P, Temmerman M (2007). "Umbilical cord anomalies are more frequent in twins after assisted reproduction". Human Reproduction. 22 (10): 2763–2767. doi:10.1093/humrep/dem191. hdl:1854/LU-373160. PMID 17720701.
- ^ Pretorius D, Chau C, Poeltler D, Mendoza A, Catanzarite V, Hollenbach K (1996). "Placental cord insertion visualization with prenatal ultrasonography". Journal of Ultrasound in Medicine. 15 (8): 585–593. doi:10.7863/jum.1996.15.8.585. PMID 8839406. S2CID 40093577.
- ^ Nomiyama M, Toyota Y, Kawano H (1998). "Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging". Ultrasound in Obstetrics and Gynecology. 12 (6): 426–429. doi:10.1046/j.1469-0705.1998.12060426.x. PMID 9918092. S2CID 35261375.
- ^ Baulies S, Maiz N, Muñoz A, Torrents M, Echevarría M, Serra B (2007). "Prenatal ultrasound diagnosis of vasa praevia and analysis of risk factors". Prenatal Diagnosis. 27 (7): 595–599. doi:10.1002/pd.1753. PMID 17497747. S2CID 37634607.
- ^ a b Vintzileos A, Ananth C, Smulian J (2015). "Using ultrasound in the clinical management of placental implantation abnormalities". American Journal of Obstetrics and Gynecology. 213 (4): S70–S77. doi:10.1016/j.ajog.2015.05.059. PMID 26428505.
- ^ Yampolsky M, Salafia C, Shlakhter O, Haas D, Eucker B, Thorp J (2009). "Centrality of the Umbilical Cord Insertion in a Human Placenta Influences the Placental Efficiency". Placenta. 30 (12): 1058–1064. doi:10.1016/j.placenta.2009.10.001. PMC 2790011. PMID 19879649.
- ^ Toivonen S, Heinonen S, Anttila M, Kosma V, Saarikoski S (2002). "Reproductive Risk Factors, Doppler Findings, and Outcome of Affected Births in Placental Abruption: A Population-Based Analysis". American Journal of Perinatology. 19 (8): 451–460. doi:10.1055/s-2002-36868. PMID 12541219. S2CID 259998340.
- ^ Hasegawa J, Matsuoka R, Ichizuka K, Kotani M, Nakamura M, Mikoshiba T, Sekizawa A, Okai (2009). "Atypical variable deceleration in the first stage of labor is a characteristic fetal heart-rate pattern for velamentous cord insertion and hypercoiled cord". Journal of Obstetrics and Gynaecology Research. 35 (1): 35–39. doi:10.1111/j.1447-0756.2008.00863.x. PMID 19215545. S2CID 11157923.