Velamentous Cord Insertion

Velamentous Cord Insertion

Interventions

• Intervention is tough-Major risk of tearing the cord vasculature
• Complications of intervening are major=Usually end in the death of the baby
• Best interventions is early detection via US, FHM
• If VC is suspected, may need emergency C/S

Nursing Implications

• Bed rest may be prescribed.
• All appointments should be kept: fetal testing, laboratory assessments, and prenatal care.
• Hemorrhage is a concern.
• Birth plan may be altered if cesarean birth is necessary

Criteria used to Diagnose VC

Incorrect placement of umbilical cord

• Normal insertion is in the center of the placenta.
• Velamentous cord insertion is on the edge of the placenta.
• Vessels lack the protection of Wharton's jelly.
• Leaves the vessels vulnerable to tearing
• Condition is often associated with vasa previa.

Umbilical Cord

• Vaginal bleeding accompanied by fetal heart irregularities
• Vaginal blood determined to be of fetal origin
• Palpation of vasa previa through a dilated cervix (rarely performed)
• Visualization of vasa previa or VC through the amnioscope or US
• Marked fetal bradycardia when the membranes are unruptured and there is no evidence of vaginal bleeding

the lifeline

• Umbilical cord develops between 4th and 8th week
• Umbilical cord implants into the placenta
• Two arteries that carry waste away
• One vein that carries oxygen and nutrients in
• The three vessels are covered by protective coating called Wharton's jelly

Risk Factors for VC

• Chronic HTN
• Previous history of VC of vasa previa
• Type 1 diabetes, GDM
• Use of assisted reproductive technology
• Women over age 35

References

Impact on Mom/Baby Nursing

Questions/Comments?

• If the vasculature tears during pregnancy/delivery, leads to death of the fetus due to desanguination
• Incidence of ~1-7.8% in single child pregnancies
• Rises to ~9-16.9% in twin pregnancies (almost 1/10)
• Ultrasounds are not an exact science (disorder goes undiagnosed)

• Canda, M. T., Demir, N., & Doganay, L. (2013). Velamentous and Furcate Cord Insertion with Placenta Accreta in an IVF Pregnancy with Unicornuate Uterus. Case Reports in Obstetrics and Gynecology, 2013, 539379. http://doi.org/10.1155/2013/539379

• Clark, J. F. J. (1984). Fetal Heart Monitoring in Detecting Velamentous Insertion of the Umbilical Cord. Journal of the National Medical Association, 76(3), 292–294.

• Ebbing, C., Kiserud, T., Johnsen, S. L., Albrechtsen, S., & Rasmussen, S. (2013). Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies. PLoS ONE, 8(7), e70380. http://doi.org/10.1371/journal.pone.0070380

• Rocha, J., Carvalho, J., Costa, F., Meireles, I., & do Carmo, O. (2012). Velamentous Cord Insertion in a Singleton Pregnancy: An Obscure Cause of Emergency Cesarean—A Case Report. Case Reports in Obstetrics and Gynecology, 2012, 308206. http://doi.org/10.1155/2012/308206