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Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality.
In Type 1, there is a velamentous insertion with vessels running over the cervix. In Type 2, unprotected vessels run between lobes of a bilobed or succenturiate lobed placenta. In Type 3, a portion of the placenta overlying the cervix undergoes atrophy. In this type, there is a normal placental cord insertion and the placenta has only one lobe.
This state of low pressure acutely causes hypovolemia, resulting in ischemia and poor end-organ perfusion. [3] Placentation Theory: The incidence of velamentous cord insertion, an abnormal insertion of the umbilical cord into the placenta, is higher in TTTS. The exact mechanism of effect this has on fetal damage is unknown.
Besides placenta previa and placental abruption, uterine rupture can occur, which is a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, but may occur with two conditions called vasa previa and velamentous umbilical cord insertion where the fetal blood vessels lie near the placental insertion site unprotected by Wharton's jelly of the cord. [11]
Causes of increased foetal-maternal haemorrhage are seen as a result of trauma, placental abruption or may be spontaneous with no cause found. Up to 30ml of foetal-maternal transfusion may take place with no significant signs or symptoms seen in either mother or foetus . [ 3 ]
In placental mammals, the umbilical cord (also called the navel string, [1] birth cord or funiculus umbilicalis) is a conduit between the developing embryo or fetus and the placenta. During prenatal development , the umbilical cord is physiologically and genetically part of the fetus and (in humans) normally contains two arteries (the umbilical ...
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These factors are known to be the primary pathophysiology cause placental disease. Which is considered to be associated with more than half of premature births. [4] Abnormalities present within the spiral arteries lead to higher velocities in blood, in turn causes the maternal villi to shred. [5]