A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population that has barriers to accessing health care.

Conflict(s) of Interest

All Authors have no conflict of interest to disclose.

References with DOI

1. West Virginia Department of Health and Human Resources. Bureau for Public Health. January 2015.

2. Committee Opinion No. 586. Obstetrics & Gynecology. 2014;123(2, PART 1):384-388.

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

4. Raisanen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S. Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study. Eur J Obstet Gynaecol Reprod Biol. 2012;165(2):231-234. https://doi.org/10.1016/j.ejogrb.2012.08.021

5. Wiedaseck S, Monchek R. Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management. J Midwifery Womens Health. 2014;59(3):328-335. https://doi.org/10.1111/jmwh.12189

6. Rebarber A, Dolin C, Fox N, Klauser C, Saltzman D, Roman A. Natural History of Vasa Previa Across Gestation Using a Screening Protocol. Journal of Ultrasound in Medicine. 2013;33(1):141-147. https://doi.org/10.7863/ultra.33.1.141

7. Cipriano L, Barth W, Zaric G. The cost-effectiveness of targeted or universal screening for vasa praevia at 18- 20 weeks of gestation in Ontario. BJOG: An International Journal of Obstetrics & Gynaecology. 2010;117(9):1108-1118. https://doi.org/10.1111/j.1471-0528.2010.02621.x