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

Abstract

Objectives

Vasa praevia rupture in velamentous insertion of the umbilical cord: The importance of prenatal diagnosis

“…Other authors report a sensitivity of 62.5% in antenatal detection of velamentous insertion of the cord, with a positive predictive value of 100% and a negative predictive value of 99.6%. 18 According to Lee et al, vasa praevia can be identified from the second trimester of pregnancy. 19 Nevertheless, given that some cases of vasa praevia resolve themselves spontaneously at the end of the pregnancy, they consider it reasonable to confirm the diagnosis in the third trimester, when its detection has the greatest impact on treatment.…”

Umbilical Cord Insertion to the Lower Uterine Segment Is a Risk Factor for Vasa Previa

“…The lower uterine segment has insufficient decidual formation and elongated by extension of the uterine isthmus as gestation advances. Cases of velamentous cord insertion located on the lower uterine segment was closely associated with a very high rate of non-reassuring fetal status and should be considered analogous to vasa previa [12,13] . Vasa previa and velamentous cord insertion located on the lower uterine segment may be associated with extension of the lower uterine segment and atrophy of the chorion villosum that covers the lower segment of the uterus.…”

Ruptured vasa previa in velamentous cord insertion placenta

“…Sepulveda 4 subsequently reported a 100% success rate in identifying cord insertion site at 11 to 14 weeks ultrasound scan in 533 cases with only 30 s added to the overall time. At 18 to 20 weeks scan in 3,446 pregnancies by general obstetricians and gynecologists with and without additional color Doppler, Hasegawa et al 5 reported 62.5% sensitivity of antenatal detection of velamentous cord insertion with 100% positive predictive value and 99.6% negative predictive value. Although we perform obstetric ultrasound in nearly all of our patients, only a minority of sonographers look for the site of cord insertion in the placenta.…”