PP-013 A Happy ending of a velamentous cord insertion

Velamentous Cord Insertion is an umbilical cord attachment to the membranes surrounding the placenta instead of the central mass. The estimated incidence was 0,4% - 11% in singleton pregnancies, with higher incidence in twin pregnancies (1.6% -40%).
Velamentous cord insertion was associated with adverse perinatal outcomes, most notably pre-term birth and emergency caesarean section in singleton pregnancies, and perinatal mortality in twins; however, the prenatal diagnosis is based upon the presence of characteristic sonographic findings (membranous umbilical vessels) at the placental cord insertion, this becomes more difficult with advancing gestation.

A 32 year old woman, gravid 2, para 1, with 24 weeks low-risk gestation came to our clinic to have a routine transabdominal ultrasonography with a suspicion velamentous cord insertion.      The fetal growth was normal, the cord seemed to end some centimetres from the placenta, at which point the umbilical vessels separate from each other and cross between the amnio and chorion before connecting to the subchorionic vessels of the placenta, located on the anterior wall. Colour doppler imaging enhances identification of the vessels (Figure1).       The suspicion of velamentous cord insertion was done at 12 weeks' gestation scan when
the site of placental cord insertion seemed localized at the edge of
the placental disk (Figure 2).

I warned for adverse perinatal outcome (fetal growth restriction, need for caesarean delivery, intrapartum and postpartum bleeding) and I advised pregnancy monitoring more closely. She did several scans and the suspicion of velamentous cord insertion was strong in all of them, especially with the use of colour doppler. Fetal growth was normal and compatible with 12th weeks scan.
This clinical information was very important to the clinical team when she was admitted to the hospital in labour at 39 th weeks gestation. A vaginal delivery it happened.
A female infant was delivered, weighing 3100 gr, with Apgar score of 8 and 9 at 1st and 5th min. There was no record of neonatal or obstetric complications. After giving birth to the baby, the mother was instructed to expel the placenta, which according to her was like having another birth. A small placenta with velamentous cord insertion were observed (Figure 3)

This case was approached with care in his surveillance, although velamentous cord insertion was suspected before birth, many of its sequelae are only identified in the intrapartum period. Its definitive diagnosis is made by local examination of the placenta, cord and membranes after birth and can have a serious outcome. The sooner it is suspected and therefore monitored, the better the prognosis.