Abstract
Purpose
Velamentous umbilical cord insertion (VCI) is associated with adverse pregnancy outcomes. Literature lacks data on Doppler. We aimed to evaluate obstetric outcomes and results of uterine and umbilical artery Doppler flowmetry associated with VCI.
Materials and methods
In a retrospective case–control study, 108 singleton pregnancies with VCI were age- and body mass index-matched to 108 singleton pregnancies without VCI. The main outcome parameters were obstetric outcome, pregnancy-related complications, uterine artery flowmetry at the second-trimester screening, and umbilical artery flowmetry before delivery. Statistical analysis was accomplished using Pearson’s Chi-square test or Fisher’s exact test, and the Mann–Whitney U test, where appropriate.
Results
Pregnancies with VCI revealed a significantly higher PI in the umbilical artery during the last measurement before delivery (1.00 ± 0.25 vs. 0.90 ± 0.10; p = 0.001). Gestational age at this measurement did not differ between the groups. Fetal malformations and intrauterine fetal death were more common in pregnancies with VCI (12.7 vs. 0 %; p < 0.001, and 6.5 vs. 0 %; p = 0.014, respectively). Patients with VCI delivered significantly earlier (36.2 ± 4.5 vs. 38.4 ± 2.6; p < 0.001).
Conclusion
Higher rates of (early) preterm delivery were found in pregnancies with VCI. Fetuses with VCI also suffered from malformations and IUFD more frequently. The last pulsatility index value in the umbilical artery, before delivery, was significantly higher in pregnancies with VCI, which is of uncertain clinical value.
Similar content being viewed by others
References
Sepulveda W, Rojas I, Robert JA et al (2003) Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study. Ultrasound Obstet Gynecol 21:564–569
Kouyoumdjian A (1980) Velamentous insertion of the umbilical cord. Obstet Gynecol 56:737–742
Lopriore E, Sueters M, Middeldorp JM et al (2007) Velamentous cord insertion and unequal placental territories in monochorionic twins with and without twin-to-twin-transfusion syndrome. Am J Obstet Gynecol 196:159e1–159e5
Kent EM, Breathnach FM, Gillan JE et al (2011) Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective ESPRiT Study. Am J Obstet Gynecol 205:376e1–376e7
Pinar H, Carpenter M (2010) Placenta and umbilical cord abnormalities seen with stillbirth. Clin Obstet Gynecol 53:656–672
Loos RJ, Derom C, Derom R, Vlietinck R (2001) Birthweight in liveborn twins: the influence of the umbilical cord insertion and fusion of placentas. BJOG 108:943–948
Benirschke K, Masliah E (2001) The placenta in multiple pregnancy: outstanding issues. Reprod Fertil Dev 13:615–622
Machin GA (2004) Why is it important to diagnose chorionicity and how do we do it? Best Pract Res Clin Obstet Gynaecol 18:515–530
Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E (2011) Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 284:47–51
Costa-Castro T, De Villiers S, Montenegro N et al (2013) Velamentous cord insertion in monochorionic twins with or without twin–twin transfusion syndrome: does it matter? Placenta 34:1053–1058
Ebbing C, Kiserud T, Johnsen SL et al (2013) Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a polulation-based study of 634,741 pregnancies. Plos One 8:e70380
Kush ML, Jenkins CB, Baschat AA (2003) Variable umbilical artery end-diastolic velocity: a possible sign of velamentous cord insertion in monochorionic gestation. Ultrasound Obstet Gynecol 21:95–96
Thompson JL, Kuller JA, Rhee EH (2012) Antenatal surveillance of fetal growth restriction. Obstet Gynecol Surv 67:554–565
Everett TR, Lees CC (2012) Beyond the placental bed: placental and systemic determinants of the uterine artery Doppler waveform. Placenta 33:893–901
Bolz N, Kalache KD, Proquitte H et al (2013) Value of Doppler sonography near term: can umbilical and uterine artery indices in low-risk pregnancies predict perinatal outcome? J Perinat Med 41:165–170
Kumral A, Okyay E, Guclu S, Gencpinar P, Islekel GH, Oguz SS, Kant M, Demirel G, Duman N, Ozkan H (2013) Cord blood ischemia-modified albumin: is it associated with abnormal Doppler findings in complicated pregnancies and predictive of perinatal asphyxia? J Obstet Gynaecol Res 39:663–671
Yampolsky M, Salafia CM, Shlakhter O et al (2009) Centrality of the umbilical cord insertion in a human placenta influences the placental efficiency. Placenta 30:1058–1064
Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S (1996) Perinatal diagnostic evaluation of velamentous umbilical cord insertion: clinical, Doppler, and ultrasonic findings. Obstet Gynecol 87:112–117
Eddleman KA, Lockwood CJ, Berkowitz GS et al (1992) Clinical significance and sonographic diagnosis of velamentous umbilical cord insertion. Am J Perinatol 9:123–126
Baumfeld Y, Gutvirtz G, Shoham I, Scheiner E (2015) Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion. Arch Gynecol Obstet. doi:10.1007/s00404-015-3819-6
Räisänen S, Georgiadis L, Harju M et al (2012) Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cors insertion: a retrospective population-based register study. Eur J Obstretics Gynecol Reprod Biol 165:231–234
Delbaere I, Goetgeluk S, Derom C et al (2007) Umbilical cord anomalies are more frequent in twins after assisted reproduction. Hum Reprod 22:2763–2767
Sepuvelda W (2006) Velamentous insertion of the umbilical cord. A first-trimester sonographic screening study. J Ultrasound Med 25:963–968
Nomiyama M, Toyota Y, Kawano H (1998) Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging. Ultrasound Obstet Gynecol 12:426–429
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Yerlikaya, G., Pils, S., Springer, S. et al. Velamentous cord insertion as a risk factor for obstetric outcome: a retrospective case–control study. Arch Gynecol Obstet 293, 975–981 (2016). https://doi.org/10.1007/s00404-015-3912-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-015-3912-x