Velamentous cord insertion

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. 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. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture. The exact cause of velamentous cord insertion is unknown, although risk factors include nulliparity, the use of assisted reproductive technology, maternal obesity, and pregnancy with other placental anomalies. Velamentous cord insertion is often diagnosed using an abdominal ultrasound. This is most successful in the second trimester, however Color Doppler ultrasound or transvaginal ultrasound 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. Management strategies for velamentous cord insertion also involve determining the presence of vasa previa. Velamentous cord insertion impacts fetal development during pregnancy by impairing the development of the placenta and modifying the efficiency of placental function. This can manifest in a range of adverse perinatal outcomes, such as fetal growth restriction, placental abruption, abnormal fetal heart rate patterns, and fetal death. Velamentous cord insertion affects between 0.