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Perinatal Diagnostic Evaluation of Velamentous Umbilical Cord Insertion: Clinical, Doppler, and Ultrasonic Findings

Obstetrics & Gynecology: January 1996
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Objective To evaluate the association between velamentous cord insertion and adverse pregnancy outcome in singleton pregnancies, and to assess the diagnostic usefulness of nonstress testing (NST) and Doppler ultrasound in this condition.

Methods We retrospectively reviewed 12,750 consecutive singleton, chromosmally normal pregnancies from July 1989 through December 1993 at the University Hospital of Kuopio, Finland. Of these, 216 were complicated by velamentous umbilical cord insertion, whereas the remaining 12,534 were normal controls. Using multiple regression analysis, we evaluated the risks by noting adverse infant outcomes: low birth weight (LBW), small for gestational age (SGA), preterm delivery, fetal death, admission to a specific infant care unit, low Apgar scores, neonatal acidemia, and abnormal intrapartum fetal heart rate (FHR) patterns. At prenatal visits NST and Doppler ultrasound examinations were carried out as a routine part of obstetric care.

Results Even after we controlled for confounding factor, velamentous umbilical cord insertion was associated with higher risk of LBW (odds ratio [OR] 2.32), SGA (OR 1.54), preterm delivery (OR 2.12), low Apgar scores at 1 and 5 minutes (ORs 1.76 and 2.47, respectively), and abnormal intrapartum FHR pattern (OR 1.59). Only 5% of the patients with abnormal insertion showed pathologic NST results at prenatal visits. Ultrasonographic examination was carried out on 80 patients with velamentous umbilical cord insertion as a routine part of obstetric care, and in only one case was direct visualization of the abnormal insertion successfull. After we excluded pregnancies with preeclampsia, abnormalumbilical artery Doppler velocimetry was found in none of the cases examined (n = 48).

Conclusion There were substantial differences in pregnancy outcome measures between the subjects with velamentous umbilical cord insertion and controls. Current antepartum methods of tracing uteroplacental problems are not effective in the prenatal detection of abnormal insertion. Therefore, in future studies, the use of other diagnostic tools, such as color Doppler imaging of cord insertion, should be evaluated in high-risk pregnancies followed-up because of fetal growth restriction.

Address reprint requests to: Markku Ryynänen, MD, Department of Obstetrics and Gynecology, University Hospital of Kuopio, 70211 Kuopio, Finland.

© 1996 The American College of Obstetricians and Gynecologists