Velamentous Cord Insertion

The velamentous insertion of the umbilical cord into the fetal membranes: In other words, the fetal vessels insert between amnion and chorion. This leaves them susceptible to ripping when the amniotic sac ruptures.

Epidemiology

■ 1% of single pregnancies

Clinical Presentation

Vaginal bleeding with fetal distress

Management

Correction of shock and immediate C-section o

All pregnant patients with a previous cesarean section must be consented for an elective "trial of labor" (vaginal delivery) with knowledge of the risk of uterine rupture:

< 1% if previous low transverse C-section x 1

< 2% if previous low transverse C-section x 2 10% if previous classical C-section x 1

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