Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging

Abstract

We could consistently identify cord insertion and velamentous cord insertion with color Doppler imaging during routine sonography in the mid-trimester. Transvaginal color Doppler imaging and serial scans were needed to identify vasa previa.

Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review

“…In seven cases, there was information on additional ultrasound findings including a low-lying placenta and VCI in three cases 25,26 and VCI alone in two cases. 17,28 The mean (SD) gestational at the time of diagnosis was 23+6 (7+1) weeks. Information on the mode of delivery was available in eight cases including five elective and three emergency caesarean sections, two for premature rupture of the membranes 27,28 and one for preeclampsia.…”

Velamentous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart rate abnormalities

“…the sensitivity of diagnosing a VCI was low when the CI was located on the posterior wall. However, using routine color Doppler scanning, Sepulveda et al 3 and Nomiyama et al 4 identified the placental cord insertion site in more than 99% of their cases. In all cases of less than 30 weeks' gestation, they were able to identify the CI regardless of placenta location 3 .…”

“…Pretorius et al reported that the detection rate of CI was markedly influenced by gestational age, ranging from 67% at 15-20 weeks to 30% at 36-40 weeks 6 . As visualization of the placental CI site becomes more difficult with advancing gestation, it should be evaluated in the mid trimester 3,4,8 . We found that the sensitivity of detection of VCI at 18-20 weeks was 62.5%, the specificity was 100%, and the PPV was 100%.…”

Vasa Previa Diagnosis and Management

“…Nomiyama et al 28 reported that the placental cord insertion could be identified in 99.8% of 587 patients scanned between 18 and 20 weeks. The sensitivity for identifying velamentous insertion was 100%, the specificity was 99.8%, the positive predictive value was 83%, and the negative predictive value was 100%.…”