Velamentous cord insertion

Signs and symptoms of velamentous cord insertion during pregnancy include blood vessel compression,{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} decrease in blood supply to the fetus,{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }} and impaired growth and development of the fetus.{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }}{{cite journal | vauthors=Eddleman K, Lockwood C, Berkowitz G, Lapinski R, Berkowitz R | title= Clinical Significance and Sonographic Diagnosis of Velamentous Umbilical Cord Insertion | journal = American Journal of Perinatology | date = 1992 | volume = 9 | issue = 2 | pages = 123–126| doi= 10.1055/s-2007-994684 | pmid= 1590867 | s2cid= 39286973 }} Blood tests taken in the second trimester may reveal increased levels of serum human chorionic gonadotropin and reduced levels of alpha-fetoprotein.{{cite journal | vauthors=Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S | title= Velamentous umbilical cord insertion may be suspected from maternal serum alpha-fetoprotein and hCG | journal = BJOG | date = 1996 | volume = 103 | issue = 3 | pages = 209–213| doi= 10.1111/j.1471-0528.1996.tb09707.x | pmid= 8630303 | s2cid= 74179289 }}{{cite journal | vauthors=Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S | title= Elevated Midtrimester Maternal Serum hCG in Chromosomally Normal Pregnancies is Associated with Preeclampsia and Velamentous Umbilical Cord Insertion | journal = American Journal of Perinatology | date = 1996 | volume = 13 | issue = 7 | pages = 437–441| doi= 10.1055/s-2007-994384 | pmid= 8960614 | s2cid= 45427947 }} The mother may also experience vaginal bleeding, particularly in the third trimester. Women with velamentous cord insertion may not experience any symptoms throughout pregnancy. During delivery, there may be slow or abnormal fetal heart rate patterns{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }} and there may be excessive bleeding or hemorrhage, particularly if the fetal vessels rupture.{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title=Third stage of labor risks in velamentous and marginal cord insertion: a population-based study | journal = Acta Obstetricia et Gynecologica Scandinavica | date = 2015 | volume = 94 | issue = 8 | pages = 878–883| doi=10.1111/aogs.12666 | pmid=25943426 | s2cid=45614777 | doi-access=free }}

The exact mechanisms leading to insertion of the umbilical cord in the fetal membranes are unknown, although they are likely to occur in the first trimester.{{cite journal | vauthors=Sepulveda W | title= Velamentous Insertion of the Umbilical Cord | journal = Journal of Ultrasound in Medicine | date = 2006 | volume = 25 | issue = 8 | pages = 963–968| doi= 10.7863/jum.2006.25.8.963 | pmid= 16870889 | s2cid= 43165100 | doi-access= }} One theory is that velamentous cord insertion may arise from the process of placental trophotropism, which is the phenomenon where the placenta migrates towards areas which have better blood flow with advancing gestation. The placenta grows in regions with better blood supply and portions atrophy in regions of poor blood flow. This process of atrophy may result in the exposure of umbilical blood vessels, causing marginal or peripheral placental insertion to evolve to velamentous insertion over time.{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}

Placentas with velamentous cord insertion have a lower vessel density.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} As the growth of the fetus is dependent on the organization, mass, and nutrient-transfer capacity of the placenta, fetal development is hence hindered in velamentous cord insertion. This can lead to fetal malformations{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Yerlikaya G, Pils S, Springer S, Chalubinski K, Ott J | title= Velamentous cord insertion as a risk factor for obstetric outcome: a retrospective case–control study | journal = Archives of Gynecology and Obstetrics | date = 2015 | volume = 293 | issue = 5 | pages = 975–981| doi= 10.1007/s00404-015-3912-x | pmid= 26498602 | s2cid= 1011746 }} and low birth weight.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }} The umbilical vessels may also be longer compared to normal,{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} particularly when the site of velamentous cord insertion is in the lower uterine section as the extension of the uterine isthmus as pregnancy advances causes vessel elongation.{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }} This results in increased vascular resistance, which impedes nutrient transfer to the fetus.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}

The umbilical vessels experience increased pressure and compression as they are not protected by Wharton's jelly. This can cause decreased or acute cessation of blood flow, decreased cardiac output, and pulmonary complications in the newborn.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} The elongated, exposed vessels in lower velamentous cord insertion cases are more readily compressed by the fetus, hence there is an even greater risk of non-reassuring fetal heart rate pattern and emergency caesarean section.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}

The growth-restricting impacts of placental insufficiency resulting from velamentous cord insertion can also augment the effects of increased pressure to the umbilical vessels.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} Normally in the second half of pregnancy, one-third of fetal cardiac output is directed towards the placenta. This fraction is reduced to around one-fifth in the last few weeks of pregnancy, while the remaining umbilical blood is recirculated in the fetal body, corresponding with decreased fetal reserves of oxygen.{{cite journal | vauthors=Kiserud T, Ebbing C, Kessler J, Rasmussen S | title= Fetal cardiac output, distribution to the placenta and impact of placental compromise | journal = Ultrasound in Obstetrics and Gynecology | date = 2006 | volume = 28 | issue = 2 | pages = 126–136| doi= 10.1002/uog.2832 | pmid= 16826560 | s2cid= 25954526 | doi-access= free }} In pregnancies with growth restriction, the fraction of fetal cardiac output distributed to the placenta decreases, further lowering fetal reserves.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} This can result in increased risk of caesarean delivery, fetal hypoxia, and perinatal death in pregnancies with velamentous cord insertion.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}

Damage to the umbilical cord vessels can occur when the amniotic membranes are ruptured, particularly in the case of vasa previa, potentially leading to fetal exsanguination.{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}{{cite journal | vauthors=Furuya S, Kubonoya K, Kubonaya K | title= Prevalence of velamentous and marginal umbilical cord insertions; a comparison of term singleton ART and non-ART pregnancies | journal = Fertility and Sterility | date = 2014 | volume = 102 | issue = 3 | pages = e313| doi= 10.1016/j.fertnstert.2014.07.1063 | doi-access = free }}{{cite journal | vauthors=Robert J, Sepulveda W | title= Fetal exsanguination from ruptured vasa previa: still a catastrophic event in modern obstetrics | journal = Journal of Obstetrics and Gynaecology | date = 2003 | volume = 23 | issue = 5 | pages = 574| doi= 10.1080/0144361031000156636 | pmid= 12963533 | s2cid= 36906136 }} If the umbilical vessels are positioned such that their rupture is likely during labor, an elective operative birth at 35–36 weeks gestation may be planned, and corticosteroids may be administered in order to assist with fetal lung maturation.{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }} Overall, velamentous cord insertion doubles the risk of both preterm birth and acute caesarean section.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}

The following have been identified as risk factors for velamentous cord insertion:

• Nulliparity{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}
• History of infertility{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}
• The use of assisted reproductive technology{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}
• Multiple gestation{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Furuya S, Kubonoya K, Kubonaya K | title= Prevalence of velamentous and marginal umbilical cord insertions; a comparison of term singleton ART and non-ART pregnancies | journal = Fertility and Sterility | date = 2014 | volume = 102 | issue = 3 | pages = e313| doi= 10.1016/j.fertnstert.2014.07.1063 | doi-access = free }}
• Maternal smoking{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}
• Maternal asthma{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Maternal obesity{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}
• Chronic hypertension{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Type 1 diabetes{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Gestational diabetes{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Placental anomalies, including low-lying placenta, bilobed placenta, placenta with accessory lobe/s{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}
• Previous pregnancy with abnormal cord insertion{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Having an umbilical cord with a single umbilical artery{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}
• Advanced maternal age{{cite journal | vauthors=Eddleman K, Lockwood C, Berkowitz G, Lapinski R, Berkowitz R | title= Clinical Significance and Sonographic Diagnosis of Velamentous Umbilical Cord Insertion | journal = American Journal of Perinatology | date = 1992 | volume = 9 | issue = 2 | pages = 123–126| doi= 10.1055/s-2007-994684 | pmid= 1590867 | s2cid= 39286973 }}{{cite journal | vauthors=Esakoff T, Cheng Y, Snowden J, Tran S, Shaffer B, Caughey A | title= Velamentous cord insertion: is it associated with adverse perinatal outcomes?| journal = The Journal of Maternal-Fetal & Neonatal Medicine | date = 2014 | volume = 28 | issue = 4 | pages = 409–412| doi= 10.3109/14767058.2014.918098| pmid= 24758363| s2cid= 1390065}}

Abdominal ultrasound can be used to visualize the insertion site of the umbilical cord.{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }} Overall, visualization is most successful in the second trimester, however routine ultrasound examination in the second trimester may not detect velamentous cord insertion if the condition develops after the remodelling of the placenta as gestation advances. Visualization becomes increasingly difficult in the third trimester as the fetus may obscure the insertion site.{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }}

The umbilical cord and its insertion site may be obscured by the fetus, such as in posterior placenta or in low-lying placenta, or may be difficult to visualise due to conditions such as maternal obesity. In these cases, the use of Color Doppler ultrasound or transvaginal ultrasound can enhance the visualization of the umbilical cord, and are able to diagnose velamentous cord insertion at 18–20 weeks.

If velamentous cord insertion is diagnosed, fetal growth is assessed every four weeks using ultrasound beginning at 28 weeks. If intrauterine growth restriction is observed, the umbilical cord is also assessed for signs of compression. Non-stress tests may be performed twice a week to ensure adequate blood flow to the fetus. The amniotic fluid may be frequently assessed for high levels of inflammatory markers such as interleukin-6 which can indicate intra-amniotic inflammation.{{cite journal | vauthors=Kenyon A, Abi-Nader K, Pandya P | title= Pre-term pre-labour rupture of membranes and the role of amniocentesis | journal = Fertility and Sterility | date = 2010 | volume = 21 | issue = 2 | pages = 75–88}}{{cite journal | vauthors=Chaemsaithong P, Romero R, Korzeniewski S, Martinez-Varea A, Dong Z, Yoon B, Hassan S, Chaiworapongsa T, Yeo L | title= A point of care test for interleukin-6 in amniotic fluid in preterm prelabor rupture of membranes: a step toward the early treatment of acute intra-amniotic inflammation/infection | journal = The Journal of Maternal-Fetal & Neonatal Medicine | date = 2015 | volume = 29 | issue = 3 | pages = 360–367| doi= 10.3109/14767058.2015.1006621 | pmid= 25758620 | pmc= 5703063 }}

Upon diagnosis of velamentous cord insertion, transvaginal ultrasound with Color Doppler may also be performed to determine whether any of the exposed vessels are within two centimeters (or five centimeters, a more common threshold recently) of the internal cervical os. If such vessels are identified, vasa previa may be present and cervical length is measured every week to determine the risk of premature rupture of membranes.

Women diagnosed with velamentous cord insertion may also receive counselling about the condition, its risks, and potential courses of action, including preterm delivery or caesarean delivery.{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}

The newborn may be delivered via normal vagina labor if there are no signs of fetal distress.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }} Fetal heart rate is continuously monitored for slow or abnormal heart rate patterns which may indicate fetal distress during labor.{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }} If the exposed blood vessels are near the cervix or are at risk of rupturing, the newborn may be delivered via caesarean section as early as 35 weeks gestation.{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}

• Vasa previa{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}
• Rupture of the vessels and membranes{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}
• Small placenta{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Low arterial cord pH
• Vascular thrombosis{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}
• Intrapartum bleeding
• Umbilical cord avulsion
• Need for caesarean delivery,{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }} curettage, manual extraction of the placenta{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}
• Placental abruption{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}
• Postpartum hemorrhage{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}

• Prematurity{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }}
• Abnormal heart rate patterns{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}
• Low birth weight{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}
• Newborn/s small for gestational age{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }}{{cite journal | vauthors=Eddleman K, Lockwood C, Berkowitz G, Lapinski R, Berkowitz R | title= Clinical Significance and Sonographic Diagnosis of Velamentous Umbilical Cord Insertion | journal = American Journal of Perinatology | date = 1992 | volume = 9 | issue = 2 | pages = 123–126| doi= 10.1055/s-2007-994684 | pmid= 1590867 | s2cid= 39286973 }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}
• Low Apgar score{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }}
• Fetal hypoxia{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}
• Pulmonary complications{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Fetal malformations{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}
• Fetal bleeding{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}{{cite journal | vauthors=Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J | title= Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study | journal = Ultrasound in Obstetrics and Gynecology | date = 2003 | volume = 21 | issue = 6 | pages = 564–569| doi= 10.1002/uog.132 | pmid= 12808673 | s2cid= 1788491 }}
• Death{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }}{{cite journal | vauthors=Eddleman K, Lockwood C, Berkowitz G, Lapinski R, Berkowitz R | title= Clinical Significance and Sonographic Diagnosis of Velamentous Umbilical Cord Insertion | journal = American Journal of Perinatology | date = 1992 | volume = 9 | issue = 2 | pages = 123–126| doi= 10.1055/s-2007-994684 | pmid= 1590867 | s2cid= 39286973 }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}{{cite journal | vauthors=Wiedaseck S, Monchek R | title= Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management | journal = Journal of Midwifery & Women's Health | date = 2014 | volume = 59 | issue = 3 | pages = 328–335| doi= 10.1111/jmwh.12189 | pmid= 24751147 }}{{cite journal | vauthors=Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C | title= Velamentous insertion of umbilical cord with vasa praevia: case series and literature review | journal = Journal of Medicine and Life | date = 2016 | volume = 9 | issue = 2 | pages = 126–129| pmid= 27453740 | pmc= 4863500 }}

In twins, one or both of the fetuses may have velamentous cord insertion, which can lead to birth-weight discordance, where one twin weighs significantly more at birth than the other,{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Kent E, Breathnach F, Gillan J, McAuliffe F, Geary M, Daly S, Higgins J, Dornan J, Morrison J, Burke G, Higgins S, Carroll S, Dicker P, Manning F, Malone F | title= Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective EsPRIT trial | journal = American Journal of Obstetrics and Gynecology | date = 2011 | volume = 204 | issue = 1 | pages = S20| doi= 10.1016/j.ajog.2010.10.044 | doi-access = free }} and selective fetal growth restriction.{{cite journal | vauthors=Kalafat E, Thilaganathan B, Papageorghiou A, Bhide A, Khalil A | title=Significance of placental cord insertion site in twin pregnancys | journal = Ultrasound in Obstetrics & Gynecology | date = 2018 | volume = 52 | issue = 3 | pages = 378–384| doi=10.1002/uog.18914 | pmid=28976606 | s2cid=10906198 | doi-access=free }} These complications particularly arise in the case of monochorionic twins, where identical twins share the same placenta.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Sato Y | title= Increased Prevalence of Fetal Thrombi in Monochorionic-Twin Placentas. Pediatrics | journal = Pediatrics | date = 2006 | volume = 117 | issue = 1 | pages = e113–e117| doi= 10.1542/peds.2005-1501 | pmid= 16361224 | s2cid= 19061448 | doi-access= }}

Velamentous cord insertion occurs in between 0.1%-1.8% of all pregnancies,{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }} and is eight to ten times more frequent in multiple pregnancies.{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }}{{cite journal | vauthors=Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T| title=Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications | journal = Taiwanese Journal of Obstetrics and Gynecology | date = 2006 | volume = 45 | issue = 1 | pages = 21–25| doi=10.1016/S1028-4559(09)60185-6 | pmid=17272203 | doi-access = free }} This risk is doubled in the case of monochorionic twins, and tripled in the case of fetal growth restriction.{{cite journal | vauthors=Ismail K, Hannigan A, ODonoghue K, Cotter A| title= Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis | journal = Systematic Reviews | date = 2017 | volume = 6 | issue = 1| page= 242 | doi= 10.1186/s13643-017-0641-1 | pmid= 29208042 | pmc= 5718132 | doi-access= free }} It is thought that sex may be a determinant of abnormal cord insertions, however there is conflicting evidence as to whether male or female fetuses are linked to greater risk of velamentous cord insertion.{{cite journal | vauthors=Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S | title= Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies | journal = PLOS ONE | date = 2013 | volume = 8 | issue = 7 | pages = e70380| doi= 10.1371/journal.pone.0070380 | pmid= 23936197 | pmc= 3728211 | bibcode= 2013PLoSO...870380E | doi-access= free }}{{cite journal | vauthors=Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S | title= Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study | journal = European Journal of Obstetrics & Gynecology and Reproductive Biology | date = 2012 | volume = 165 | issue = 2 | pages = 231–234| doi= 10.1016/j.ejogrb.2012.08.021 | pmid= 22944380 }}

{{reflist}}

{{Medical resources

| DiseasesDB = 34591

| ICD10 = {{ICD10|O|43|1|o|30}}

| ICD9 = {{ICD9|762.6}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj = med

| eMedicineTopic = 3276

| MeshID =

}}

{{Pathology of pregnancy, childbirth and the puerperium}}

{{Certain conditions originating in the perinatal period}}

Category:Pathology of pregnancy, childbirth and the puerperium