Velamentous Cord Insertion

Velamentous cord insertion (VCI) is a pregnancy complication that happens when the umbilical cord doesn’t go into the placenta correctly. The cord inserts into membranes away from the edge of the placenta.

Typically, the umbilical cord travels from a fetus’s belly to inside the placenta. Here, there’s easy access to the nutrients that your body shares. A gel-like substance called Wharton’s jelly protects the umbilical cord blood vessels. It keeps them from twisting and breaking.

With velamentous (pronounced “VEL-uh-MEN-tuhs”) cord insertion, the umbilical cord blood vessels must travel much farther to get nutrients. And they must travel without the protection of Wharton’s jelly.

Without easy access to nutrients, a fetus may develop more slowly. Because of this potential issue, it’s a high-risk pregnancy. But it’s still possible to have a healthy pregnancy and baby.

According to one study, VCI affects about 1 in 100 pregnancies with one fetus. It affects about 3 in 50 pregnancies with multiple fetuses (like twins). The rate increases to about 3 in 20 for twins who share the same placenta (MCDA twins).

Symptoms of velamentous cord insertion

VCI doesn’t have symptoms that you can feel. The only way to know if VCI affects your pregnancy is with prenatal ultrasounds. Your healthcare provider can diagnose it this way.

Velamentous cord insertion causes

Researchers don’t know for sure what causes velamentous cord insertion. But it tends to show up more often in pregnancies that:

• Happen because of assisted reproduction technology, like IVF
• Involve a first-time birth mother
• Involve twins, especially twins that share a placenta
• Have placenta previa — when the placenta covers your cervix

Smoking also increases the risk of VCI.

Complications of this condition

Velamentous cord insertion can slow fetal growth. Rarely, the blood vessels in the umbilical cord can break and bleed. These issues can increase the risk of:

• Preterm birth: Your baby may need to be delivered before 37 weeks of pregnancy.
• Preeclampsia: Your blood pressure may rise after 20 weeks of pregnancy.
• Placental abruption: The placenta may separate from the wall of your uterus, leading to severe blood loss.
• Emergency C-section: You may need this surgery to deliver your baby if you have heavy bleeding.
• Stillbirth: The fetus may die sometime after 20 weeks of pregnancy.

Your pregnancy care provider will do everything they can to prevent these complications. Lean on them for medical guidance.

Vasa previa

Some pregnancies with velamentous cord insertion also have a rare but serious complication called vasa previa. With vasa previa, exposed blood vessels are at a very high risk of bursting when the fetus starts putting pressure on your cervix during labor. It’s dangerous to both you and the fetus.

Getting diagnosed early can prevent this from happening. If your healthcare provider sees exposed blood vessels near your cervix, they’ll likely suggest a C-section.

Complications after birth

VCI can affect your baby after birth. They may:

• Have underweight or look smaller when compared to other newborns
• Need special care in a neonatal ICU unit
• Have low Apgar scores

A pediatric team will do a thorough health evaluation right after your baby is born.

How doctors diagnose this condition

Healthcare providers use an ultrasound to diagnose velamentous cord insertion.

By your second trimester, your provider should be able to see where the umbilical cord inserts with an ultrasound. A color Doppler ultrasound provides an even clearer picture.

If you don’t have an ultrasound until your third trimester, it may be harder for your provider to see the umbilical cord and make a diagnosis. This is because the fetus is much larger and may make it hard to see the cord.

How is it treated?

There’s no way to treat velamentous cord insertion. Instead, your healthcare provider will take extra precautions to reduce any risks. Your provider may:

• Monitor the fetus’s growth every four to six weeks.
• Do regular non-stress tests on the fetus to check the fetal heart rate in response to movement.
• Schedule a C-section if there’s concern that you have a vasa previa.
• Induce delivery before 40 weeks of pregnancy if you’re delivering your baby vaginally.
• Take extra care to monitor your baby’s vitals during labor to ensure a safe delivery.

What can I expect if I have this condition?

Your healthcare provider is the best resource to advise you on the safest plan for your pregnancy. They can let you know what to expect in the days leading up to delivery and after your baby is born.

Talk with your provider to understand what velamentous cord insertion means for your pregnancy. Each case is different. Follow your provider’s instructions for how to best care for yourself each day.