Abstract
Approximately 2% of low-risk pregnant women still require an emergency Cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. Velamentous cord insertion is an abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta. With a reported incidence of 1% in singleton pregnancies, it has been associated with several obstetric complications. This condition has been diagnosed by ultrasonography with a sensitivity of 67% and specificity of 100% in the second trimester. The present case highlights the importance of the systematic assessment of the placental cord insertion site at routine obstetric ultrasound and the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications.
Highlights
The umbilical cord normally inserts into the central portion of the placenta, well away from the placental edge
Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women [1]
Because of the lack of protection from Wharton’s jelly, these vessels are prone to compression and rupture, especially when they are located in the membranes covering the cervical ostium
Summary
The umbilical cord normally inserts into the central portion of the placenta, well away from the placental edge. The site of placental cord insertion (CI) is considered abnormal when it is located at the edge of the placental disk or when the umbilical vessels separate from each other and course between the amnion and chorion before reaching the placenta (velamentous CI, VCI) [1]. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women [1]. Velamentous cord insertion (VCI) is an abnormal cord insertion (CI) in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta It is characterized by membranous umbilical vessels at the placental insertion site; the remainder of the cord is usually normal. The present case is valuable to reflect the importance of prenatal diagnosis of this clinical scenario
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