Your umbilical cord is your baby’s lifeline. It carries nutrient-rich blood and oxygen to your baby and removes wasted products. Complications of the umbilical cord can cause issues during your pregnancy or during delivery. Velamentous cord insertion is one such condition.
A velamentous cord insertion is one of the rare pregnancy complications when the umbilical cord is in an abnormal location in the placenta. In a normal gestational sac, the umbilical cord is located in the middle of the placenta (central insertion). Also, the amniotic sac is entirely enclosing the cord.
Additionally, the baby’s blood vessels travel or go from the center of the placenta into the baby through the umbilical cord.
In this article, we will be talking about velamentous cord insertion and its risks, treatment, and how to diagnose it. Even if it is a rare condition, we don’t want to let that happen to you when it is too late to resolve.
What is velamentous cord insertion?
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Velamentous cord insertion affects the baby’s connection to the placenta, which develops when mothers are pregnant. The placenta is a special organ with a composition of tissue from both the baby and the mother. This is where the exchange of oxygen, nutrients, and wastes takes place.
The placenta attaches to the wall of the uterus or womb, and it connects to the baby via the umbilical cord. Commonly, the umbilical cord is attached to the center of the placenta.
But, odd placements may occur. The cord may attach beyond the center, which is commonly not an issue. In marginal cord insertion, the cord attaches to the placenta’s edge, which may cause some health conditions.
Velamentous cord insert is a rarer problem. In this condition, the cord does not attach directly to the placenta. But, instead, the cord attaches to other membranes inside the uterus.
When this abnormal placement occurs, the blood vessels are vulnerable as they pass through the membranes. The umbilical cord can’t protect the blood vessels for their full length.
They also lack the protection of the gel-like substance filling up the umbilical cord and cushioning the blood vessels. This bereft of protection makes the blood vessels more commonly become compressed or break.
Causes and Risk factors
There is uncertainty as to what causes velamentous cord insertion, but experts have identified several risk factors. It happens more often in pregnant mothers involve in multiple pregnancies.
It commonly occurs in about 1% of pregnancies resulting in one child but in almost 9% of twin pregnancies. The rate is higher when the twins share a single or fused placenta. However, the chances are lower for twins who may have a separate placenta.
Risks of velamentous cord insertion are more likely to happen when pregnancy occurs through the use of fertility treatments, like in-vitro fertilization. It might usually be in older mothers and in first-time mothers.
The mother’s health condition can also affect the risk of unusual cord insertions like velamentous. Mothers that are smokers or who have chronic diseases like diabetes may be at higher risk.
Furthermore, miscarriages happening from the ninth to the 16th week often result in issues regarding the umbilical cord, including velamentous cord insertion.
Other risk factors to consider are the following:
- advanced maternal age
- having a female fetus
- having twins
- pregnancies conceived with assisted reproductive technology such as in-vitro fertilization
- prior abnormal cord insertion in pregnancy
Commonality
Velamentous insertion happens in 1.1% of singleton pregnancies and 8.7% of twin or multiple pregnancies. This type of insertion is common in the early trimester of pregnancy.
In cases of miscarriage, velamentous insertion occurs around 33% of the time when the pregnancy ends between nine and 12 weeks gestation. In cases of pregnancies that end between 13 and 16 weeks, the rate is a little lower at 26%.
Complications
Velamentous cord insertion may lead to some complications for the fetus. Once your baby is born, doctors may deliver them to the neonatal intensive care unit (NICU). They may have low APGAR scores (ranking of baby’s physical condition), abnormal heartbeat rate, or other physical problems.
These are the additional complications of which expecting mothers should be aware too:
Vasa Previa happens when your baby’s blood vessels run close to the inner part of the cervix. This inner part is the tissue that separates the uterus from the vagina.
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Small for gestational age
A velamentous insertion may restrict or lower the ability of the fetus to grow. It may result in an increase in the chances of having a newborn who is smaller for gestational age (SGA). These babies can be less developed or may weigh less than an average infant of the same age.
Pregnant mothers can have preeclampsia because of velamentous insertion. Preeclampsia is a complication that may result in high blood pressure and/or failure of the liver or kidneys.
An odd cord insertion may require a preterm delivery. This could mean that a pregnant woman has induced labor earlier than the scheduled birth, or it might involve a cesarean section delivery. Placental implantation issues, including velamentous cord insertion, are the cause of 5.6 to 8.7% of preterm deliveries.
How to diagnose velamentous cord insertion through ultrasound
Velamentous cord insertion can be diagnosed through an ultrasound. It might be difficult to see during the first trimester of pregnancy, but it can be easier to examine during the second trimester.
Although most moms have ultrasounds during their pregnancies, the location where the cord attaches to the placenta can be difficult to detect on ultrasounds. It will result in difficulty to diagnose velamentous insertion.
It is usually detectable during the ultrasound in the second trimester of pregnancy. However, when the baby enters the third trimester, odd cord insertion may be harder to see.
If you or your baby have uncommon symptoms during pregnancy, it may also lead to a diagnosis. The mother can have vaginal bleeding, or the baby might have a slow heartbeat rate.
If such symptoms happen, the doctor may ask for your consent for another ultrasound. Then, it would lead to the diagnosis of an unusual cord insertion.
Special technology may increase the detection chances of a velamentous insertion. A color Doppler ultrasound can detect the odd insertion with 99% accuracy in a research condition. Standard ultrasounds are less efficient to look for unusual cord insertion.
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Signs
If there are some signs that might indicate velamentous cord placement. One indicator, which can be detected by your healthcare unit during a routine ultrasound, is a decrease in your baby’s blood supply.
If the fetus is not reaching any developmental milestones during your prenatal visits, it might be another sign of a complication like a velamentous insertion. Furthermore, if you experience bleeding during pregnancy, seek immediate help from your doctor or healthcare provider.
Velamentous cord insertion treatment
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Although there is no specific prevention or treatment for velamentous cord insertion, the best way once the doctor discovers this condition is to get routine ultrasounds and close monitoring of the fetus. Your healthcare unit or midwife might also recommend a nonstress test during the third trimester. This means you will be wearing a belt with built-in censors and a tracker of your baby’s movements and heart rate.
Don’t forget to always consult with your doctor or healthcare unit during your pregnancy. Every mom’s pregnancy is precious, and we always need to take care of ourselves so that we can take care of our babies in our bellies!
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