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Velamentous Insertion Cord

Velamentous Insertion Cord is the insertion of the umbilical cord on the chorioamniotic membranes rather than on the placental mass.

There are two types of Velamentous Insertion Cord:Insertio velamentosa or inserpositio velamentosa The type is based on whether the umbilical arteries branch or not within the membranes

Velamentous Insertion Cord can be found if vasa previa is present. Vasa previa, a condition that occurs when the vessels traverse the fetal membranes below the presenting part.

Diagnosis is important due the higher risks for adverse perinatal outcome. The may intrauterine growth retardation, preterm birth, congenital anomalies, and fetal bleeding.

Other Complications of Velamentous Insertion Cord:

Esophageal atresia
◊ Obstructive uropathies
◊ Congenital hip dislocation
◊ Asymmetrical head shape
◊ Spina bifida
◊ Ventricular septal defects
◊ Trisomy 21 (Down syndrome)
Side note: A high rate of deformations instead of disruptions or malformations has been noted. The possibility of a bilobated placenta1,2 and single umbilical artery must also be considered.

Management

Once the prenatal diagnosis of velamentous insertion is made, the following issues should be stressed :

♥ to determine the exact localization of the insertion site is critical for proper obstetrical management. If the insertion site is in the lower segment, the risk of having vasa previa is increased. Therefore, a cesarean section must be offered to avoid the serious complications of fetal bleeding. On the other hand, if the insertion site is in the uterine fundus, no changes in the obstetrical management seem to be necessary. *However, the possibility of compression of the velamentous vessels should be seriously considered, and the patient should be followed-up with serial fetal heart rate monitoring in order to detect fetal distress.
♥ careful examination of the fetal anatomy, including fetal echocardiography, must be performed to rule out associated anomalies.
♥ *serial examinations for fetal growth must be offered, since the incidence of small gestational age infants (defined as birth weight two standard deviations below the mean) with a velamentous insertion of the umbilical cord has been estimated to be 7.5%. Indeed, the twin with velamentous insertion of the cord has a lower mean birth weight than the unaffected co-twin.

Note:

♥ Color flow Doppler ultrasound is helpful in the prenatal diagnosis and management of cases with velamentous insertion of the umbilical cord.
♥ The recurrence risk rate is not known to increase with subsequent pregnancies.
♥ Do NOT be afraid to ask your doctor for a color flow doppler! You have a right to feel secure in your prenatal care.

For more detailed information, please check out the reference listed below.

References:

♦Cord, velamentous insertion by Ruben Quintero, MD, Waldo Sepulveda, MD, Roberto Romero, MD *, Francisco Brandt, MD, Moshe Mazor, MD