Velamentous cord insertion - an important obstetrical risk factor

A velamentous insertion of the umbilical cord is characterized by the atypical aspect of the placental end of the cord, consisting in divergent umbilical vessels surrounded by fetal membranes and with no Wharton’s jelly present, resulting a cord that is inserted rather into membranes than the placental disk. By the divergence of the umbilical vessels as they travers the amnion and the chorion before reaching the placenta this condition associates important obstetrical complications and the diagnosis by ultrasonography as early is possible is important for the guidance of the subsequent management. In this retrospective study we aimed to evaluate the incidence of velamentous cord insertion in University Emergency Hospital of Bucharest for a period of five years and analyze the pregnancies outcome and the obstetrical impact of this condition. Using the statistics department of University Emergency Hospital Bucharest we determined an incidence of 0.23% of pregnancies complicated by velamentous cord insertion. The examined parameters included intrauterine fetal death, small for gestational age, preterm delivery (<37 weeks), single artery umbilical cord and low Apgar score at 1 minute. We chose to exemplify with a case of early diagnosis of this condition, respectively at 15 weeks of gestation. The attempt to visualize cord insertion in the mid-trimester as a routine part of obstetric sonography is recommended. The identification of velamentous cord insertion dictates the mode and timing of delivery and can improve fetal outcome