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Velamentous cord insertion

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is reduced to around one-fifth in the last few weeks of pregnancy, while the remaining umbilical blood is recirculated in the fetal body, corresponding with decreased fetal reserves of oxygen. In pregnancies with growth restriction, the fraction of fetal cardiac output distributed to the placenta decreases, further lowering fetal reserves. This can result in increased risk of caesarean delivery,
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migrates towards areas which have better blood flow with advancing gestation. The placenta grows in regions with better blood supply and portions atrophy in regions of poor blood flow. This process of atrophy may result in the exposure of umbilical blood vessels, causing marginal or peripheral placental insertion to evolve to velamentous insertion over time.
167:. This is most successful in the second trimester, however Color Doppler ultrasound or transvaginal ultrasound can be used in difficult cases, such as when the placenta is located posteriorly. If the woman is diagnosed with velamentous cord insertion, the pregnancy is closely monitored, especially as velamentous cord insertion is a strong risk factor for 229:. If the umbilical vessels are positioned such that their rupture is likely during labor, an elective operative birth at 35–36 weeks gestation may be planned, and corticosteroids may be administered in order to assist with fetal lung maturation. Overall, velamentous cord insertion doubles the risk of both preterm birth and acute caesarean section. 176:
modifying the efficiency of placental function. This can manifest in a range of adverse perinatal outcomes, such as fetal growth restriction, placental abruption, abnormal fetal heart rate patterns, and fetal death. Velamentous cord insertion affects between 0.1%-1.8% of pregnancies, though its incidence increases ten-fold in multiple pregnancies.
193:. The mother may also experience vaginal bleeding, particularly in the third trimester. Women with velamentous cord insertion may not experience any symptoms throughout pregnancy. During delivery, there may be slow or abnormal fetal heart rate patterns and there may be excessive bleeding or hemorrhage, particularly if the fetal vessels rupture. 206:
birth weight. The umbilical vessels may also be longer compared to normal, particularly when the site of velamentous cord insertion is in the lower uterine section as the extension of the uterine isthmus as pregnancy advances causes vessel elongation. This results in increased vascular resistance, which impedes nutrient transfer to the fetus.
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If velamentous cord insertion is diagnosed, fetal growth is assessed every four weeks using ultrasound beginning at 28 weeks. If intrauterine growth restriction is observed, the umbilical cord is also assessed for signs of compression. Non-stress tests may be performed twice a week to ensure adequate
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The exact mechanisms leading to insertion of the umbilical cord in the fetal membranes are unknown, although they are likely to occur in the first trimester. One theory is that velamentous cord insertion may arise from the process of placental trophotropism, which is the phenomenon where the placenta
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The growth-restricting impacts of placental insufficiency resulting from velamentous cord insertion can also augment the effects of increased pressure to the umbilical vessels. Normally in the second half of pregnancy, one-third of fetal cardiac output is directed towards the placenta. This fraction
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The umbilical vessels experience increased pressure and compression as they are not protected by Wharton's jelly. This can cause decreased or acute cessation of blood flow, decreased cardiac output, and pulmonary complications in the newborn. The elongated, exposed vessels in lower velamentous cord
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The umbilical cord and its insertion site may be obscured by the fetus, such as in posterior placenta or in low-lying placenta, or may be difficult to visualise due to conditions such as maternal obesity. In these cases, the use of Color Doppler ultrasound or transvaginal ultrasound can enhance the
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Placentas with velamentous cord insertion have a lower vessel density. As the growth of the fetus is dependent on the organization, mass, and nutrient-transfer capacity of the placenta, fetal development is hence hindered in velamentous cord insertion. This can lead to fetal malformations and low
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and are at high risk of rupture during membrane rupture in early labor. Management strategies for velamentous cord insertion also involve determining the presence of vasa previa. Velamentous cord insertion impacts fetal development during pregnancy by impairing the development of the placenta and
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Velamentous cord insertion occurs in between 0.1%-1.8% of all pregnancies, and is eight to ten times more frequent in multiple pregnancies. This risk is doubled in the case of monochorionic twins, and tripled in the case of fetal growth restriction. It is thought that sex may be a determinant of
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Abdominal ultrasound can be used to visualize the insertion site of the umbilical cord. Overall, visualization is most successful in the second trimester, however routine ultrasound examination in the second trimester may not detect velamentous cord insertion if the condition develops after the
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The newborn may be delivered via normal vagina labor if there are no signs of fetal distress. Fetal heart rate is continuously monitored for slow or abnormal heart rate patterns which may indicate fetal distress during labor. If the exposed blood vessels are near the cervix or are at risk of
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Upon diagnosis of velamentous cord insertion, transvaginal ultrasound with Color Doppler may also be performed to determine whether any of the exposed vessels are within two centimeters (or five centimeters, a more common threshold recently) of the internal cervical os. If such vessels are
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Signs and symptoms of velamentous cord insertion during pregnancy include blood vessel compression, decrease in blood supply to the fetus, and impaired growth and development of the fetus. Blood tests taken in the second trimester may reveal increased levels of serum
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Hasegawa J, Matsuoka R, Ichizuka K, Kotani M, Nakamura M, Mikoshiba T, Sekizawa A, Okai (2009). "Atypical variable deceleration in the first stage of labor is a characteristic fetal heart-rate pattern for velamentous cord insertion and hypercoiled cord".
136:. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the 897:
Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S (2012). "Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study".
144:, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the 3042: 2311: 2233: 2218: 1674:
Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S (1996). "Elevated Midtrimester Maternal Serum hCG in Chromosomally Normal Pregnancies is Associated with Preeclampsia and Velamentous Umbilical Cord Insertion".
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In twins, one or both of the fetuses may have velamentous cord insertion, which can lead to birth-weight discordance, where one twin weighs significantly more at birth than the other, and selective
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Toivonen S, Heinonen S, Anttila M, Kosma V, Saarikoski S (2002). "Reproductive Risk Factors, Doppler Findings, and Outcome of Affected Births in Placental Abruption: A Population-Based Analysis".
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Women diagnosed with velamentous cord insertion may also receive counselling about the condition, its risks, and potential courses of action, including preterm delivery or caesarean delivery.
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blood flow to the fetus. The amniotic fluid may be frequently assessed for high levels of inflammatory markers such as interleukin-6 which can indicate intra-amniotic inflammation.
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Sepulveda W, Rojas I, Robert J, Schnapp C, Alcalde J (2003). "Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study".
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Yerlikaya G, Pils S, Springer S, Chalubinski K, Ott J (2015). "Velamentous cord insertion as a risk factor for obstetric outcome: a retrospective case–control study".
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Kent E, Breathnach F, Gillan J, McAuliffe F, Geary M, Daly S, Higgins J, Dornan J, Morrison J, Burke G, Higgins S, Carroll S, Dicker P, Manning F, Malone F (2011).
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remodelling of the placenta as gestation advances. Visualization becomes increasingly difficult in the third trimester as the fetus may obscure the insertion site.
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Sinkin J, Craig W, Jones M, Pinette M, Wax J (2018). "Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies".
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Heinonen S, Ryynanen M, Kirkinen P, Saarikoski S (1996). "Velamentous umbilical cord insertion may be suspected from maternal serum alpha-fetoprotein and hCG".
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Eddleman K, Lockwood C, Berkowitz G, Lapinski R, Berkowitz R (1992). "Clinical Significance and Sonographic Diagnosis of Velamentous Umbilical Cord Insertion".
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abnormal cord insertions, however there is conflicting evidence as to whether male or female fetuses are linked to greater risk of velamentous cord insertion.
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Damage to the umbilical cord vessels can occur when the amniotic membranes are ruptured, particularly in the case of vasa previa, potentially leading to fetal
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Pretorius D, Chau C, Poeltler D, Mendoza A, Catanzarite V, Hollenbach K (1996). "Placental cord insertion visualization with prenatal ultrasonography".
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insertion cases are more readily compressed by the fetus, hence there is an even greater risk of non-reassuring fetal heart rate pattern and emergency
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Esakoff T, Cheng Y, Snowden J, Tran S, Shaffer B, Caughey A (2014). "Velamentous cord insertion: is it associated with adverse perinatal outcomes?".
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Baulies S, Maiz N, Muñoz A, Torrents M, Echevarría M, Serra B (2007). "Prenatal ultrasound diagnosis of vasa praevia and analysis of risk factors".
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identified, vasa previa may be present and cervical length is measured every week to determine the risk of premature rupture of membranes.
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Paavonen J, Jouttunpää K, Kangasluoma P, Aro P, Heinonen P (1984). "Velamentous insertion of the umbilical cord and vasa previa".
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Robert J, Sepulveda W (2003). "Fetal exsanguination from ruptured vasa previa: still a catastrophic event in modern obstetrics".
3411: 1006:"Prevalence of velamentous and marginal umbilical cord insertions; a comparison of term singleton ART and non-ART pregnancies" 2542: 2509: 2076:"Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective EsPRIT trial" 3314: 3319: 2557: 2025:
Chaemsaithong P, Romero R, Korzeniewski S, Martinez-Varea A, Dong Z, Yoon B, Hassan S, Chaiworapongsa T, Yeo L (2015).
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Normal umbilical cord insertion and velamentous umbilical cord insertion in pregnancy, with and without vasa previa.
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Kenyon A, Abi-Nader K, Pandya P (2010). "Pre-term pre-labour rupture of membranes and the role of amniocentesis".
156:. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture. 3707: 3657: 3225: 3020: 2608: 2346: 964:
Wiedaseck S, Monchek R (2014). "Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management".
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The exact cause of velamentous cord insertion is unknown, although risk factors include nulliparity, the use of
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Blood vessel compression, decrease in blood supply to the fetus, impaired growth and development of the fetus.
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visualization of the umbilical cord, and are able to diagnose velamentous cord insertion at 18–20 weeks.
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Sato Y (2006). "Increased Prevalence of Fetal Thrombi in Monochorionic-Twin Placentas. Pediatrics".
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Placental anomalies, including low-lying placenta, bilobed placenta, placenta with accessory lobe/s
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rupturing, the newborn may be delivered via caesarean section as early as 35 weeks gestation.
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Multiple gestation, placental anomalies previous pregnancy with abnormal cord insertion
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Bohiltea R, Cirstoiu M, Ciuvica A, Munteanu O, Bodean O, Voicu D, Ionescu C (2016).
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The following have been identified as risk factors for velamentous cord insertion:
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Delbaere I, Goetgeluk S, Derom C, De Bacquer D, De Sutter P, Temmerman M (2007).
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Need for caesarean delivery, curettage, manual extraction of the placenta
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European Journal of Obstetrics & Gynecology and Reproductive Biology
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Kalafat E, Thilaganathan B, Papageorghiou A, Bhide A, Khalil A (2018).
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Yampolsky M, Salafia C, Shlakhter O, Haas D, Eucker B, Thorp J (2009).
977: 164: 57: 2210: 2125: 2108: 2106: 1149: 222:, and perinatal death in pregnancies with velamentous cord insertion. 3593: 3052: 2462: 2321: 2272: 1884: 1867: 125: 1403: 772: 3386: 2356: 1777:
Sepulveda W (2006). "Velamentous Insertion of the Umbilical Cord".
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Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S (2015).
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Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S (2013).
153: 2109:"Significance of placental cord insertion site in twin pregnancys" 1673: 1630: 3109: 2661: 812: 263: 149: 1819: 1233: 1185: 696: 3113: 2665: 2222: 1722: 1067: 697:
Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T (2006).
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Pruritic urticarial papules and plaques of pregnancy (PUPPP)
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Having an umbilical cord with a single umbilical artery
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Pathology of pregnancy, childbirth and the puerperium
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The Journal of Maternal-Fetal & Neonatal Medicine
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The Journal of Maternal-Fetal & Neonatal Medicine
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Kiserud T, Ebbing C, Kessler J, Rasmussen S (2006).
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International Journal of Gynecology & Obstetrics
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Ismail K, Hannigan A, ODonoghue K, Cotter A (2017).
2905:Childbirth-related post-traumatic stress disorder 420:, where identical twins share the same placenta. 3720: 963: 1914: 287:Previous pregnancy with abnormal cord insertion 1590:Journal of Obstetrics and Gynaecology Research 703:Taiwanese Journal of Obstetrics and Gynecology 140:. The vessels are hence normally protected by 3036: 2305: 2080:American Journal of Obstetrics and Gynecology 1729:Acta Obstetricia et Gynecologica Scandinavica 1452:American Journal of Obstetrics and Gynecology 247:The use of assisted reproductive technology 3043: 3029: 2312: 2298: 1446:Vintzileos A, Ananth C, Smulian J (2015). 62: 38: 2124: 2113:Ultrasound in Obstetrics & Gynecology 2091: 2050: 1883: 1776: 1740: 1512: 1463: 1353: 1261: 1251: 1085: 1021: 1004:Furuya S, Kubonoya K, Kubonaya K (2014). 966:Journal of Midwifery & Women's Health 714: 638: 628: 504: 494: 1872:Ultrasound in Obstetrics and Gynecology 1342:Ultrasound in Obstetrics and Gynecology 1336:Nomiyama M, Toyota Y, Kawano H (1998). 761:Ultrasound in Obstetrics and Gynecology 3721: 1958: 1956: 1954: 1861: 1859: 1772: 1770: 1768: 1718: 1716: 1714: 1582: 1580: 1578: 1534: 1532: 1441: 1439: 1437: 1435: 1433: 1431: 1429: 1385: 1383: 1381: 1331: 1329: 1285: 1283: 1281: 1131: 1129: 1127: 1125: 692: 690: 688: 686: 684: 682: 680: 678: 171:, where the exposed vessels cross the 3024: 2543:Intrahepatic cholestasis of pregnancy 2510:Intrahepatic cholestasis of pregnancy 2293: 1917:Journal of Obstetrics and Gynaecology 1822:Archives of Gynecology and Obstetrics 1229: 1227: 1225: 1181: 1179: 1177: 1175: 1123: 1121: 1119: 1117: 1115: 1113: 1111: 1109: 1107: 1105: 1063: 1061: 1059: 1057: 1055: 1053: 999: 997: 995: 959: 957: 955: 953: 951: 949: 892: 890: 888: 886: 884: 882: 880: 878: 876: 874: 872: 808: 806: 804: 802: 800: 798: 754: 676: 674: 672: 670: 668: 666: 664: 662: 660: 658: 598: 596: 594: 592: 590: 588: 586: 584: 582: 580: 578: 576: 574: 572: 570: 568: 566: 564: 562: 560: 558: 556: 554: 552: 550: 548: 546: 544: 472: 470: 468: 466: 464: 462: 179: 3315:Infant respiratory distress syndrome 2609:Pregnancy-induced hypercoagulability 2155: 1051: 1049: 1047: 1045: 1043: 1041: 1039: 1037: 1035: 1033: 947: 945: 943: 941: 939: 937: 935: 933: 931: 929: 870: 868: 866: 864: 862: 860: 858: 856: 854: 852: 752: 750: 748: 746: 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1602:10.1111/j.1447-0756.2008.00863.x 1541:American Journal of Perinatology 815:American Journal of Perinatology 333: 161:assisted reproductive technology 3708:Fetal Alcohol Spectrum Disorder 3658:Group B streptococcal infection 3226:Intrauterine growth restriction 423: 232: 3051:Conditions originating in the 2490:Acute fatty liver of pregnancy 1505:10.1016/j.placenta.2009.10.001 1: 3400:Vitamin K deficiency bleeding 2692:Prelabor rupture of membranes 2043:10.3109/14767058.2015.1006621 716:10.1016/S1028-4559(09)60185-6 432: 313: 3559:Periventricular leukomalacia 3377:Persistent fetal circulation 3325:Meconium aspiration syndrome 2971:Systemic lupus erythematosus 2622:Maternal care related to the 2604:Gestational thrombocytopenia 1977:10.3109/14767058.2014.918098 1200:10.1016/0020-7292(84)90007-9 1074:Journal of Medicine and Life 912:10.1016/j.ejogrb.2012.08.021 630:10.1371/journal.pone.0070380 384:Abnormal heart rate patterns 300: 187:human chorionic gonadotropin 7: 3468:Intraventricular hemorrhage 2772:Cephalopelvic disproportion 1929:10.1080/0144361031000156636 338: 10: 3745: 3473:Germinal matrix hemorrhage 3463:Velamentous cord insertion 3354:Bronchopulmonary dysplasia 2883:Breastfeeding difficulties 2682:Constriction ring syndrome 2656:Braxton Hicks contractions 2093:10.1016/j.ajog.2010.10.044 1465:10.1016/j.ajog.2015.05.059 122:Velamentous cord insertion 25:Velamentous cord insertion 3673: 3608: 3567: 3544: 3516: 3503:Necrotizing enterocolitis 3488: 3385: 3362: 3300: 3293: 3234: 3212:Large for gestational age 3208:Small for gestational age 3200: 3164: 3132: 3106: 3074: 3063: 2996: 2953: 2920:Peripartum cardiomyopathy 2910:Pubic symphysis diastasis 2873: 2757: 2621: 2594: 2576: 2518: 2480: 2471: 2427: 2345: 2336: 2263: 2204: 1834:10.1007/s00404-015-3912-x 1791:10.7863/jum.2006.25.8.963 1304:10.7863/jum.1996.15.8.585 496:10.1186/s13643-017-0641-1 111: 101: 91: 81: 71: 51: 46: 37: 29: 24: 2446:Gestational hypertension 414:fetal growth restriction 375: 115:0.1%-1.8% of pregnancies 3665:Neonatal conjunctivitis 3156:Single umbilical artery 3146:Umbilical cord prolapse 3093:Placental insufficiency 3066:complicating pregnancy, 2845:Umbilical cord prolapse 2767:Amniotic fluid embolism 2525:dermatoses of pregnancy 2008:Fertility and Sterility 1010:Fertility and Sterility 399:Pulmonary complications 362:Umbilical cord avulsion 3641:ureaplasma urealyticum 3349:Wilson–Mikity syndrome 3273:Brachial plexus injury 2961:Concomitant conditions 2940:Postpartum thyroiditis 2718:Circumvallate placenta 2538:Impetigo herpetiformis 2533:Gestational pemphigoid 2505:Hyperemesis gravidarum 2438:hypertensive disorders 2170:10.1542/peds.2005-1501 244:History of infertility 189:and reduced levels of 3589:Congenital hypertonia 3480:Anemia of prematurity 3188:Shoulder presentation 2930:Postpartum infections 2925:Postpartum depression 1689:10.1055/s-2007-994384 1253:10.1093/humrep/dem191 827:10.1055/s-2007-994684 371:Postpartum hemorrhage 293:Advanced maternal age 124:is a complication of 3594:Congenital hypotonia 3508:Meconium peritonitis 3310:Intrauterine hypoxia 3266:Subgaleal hemorrhage 2935:Postpartum psychosis 2804:Obstetrical bleeding 2699:Obstetrical bleeding 2520:Integumentary system 2495:Gestational diabetes 2474:related to pregnancy 2472:Other, predominantly 1553:10.1055/s-2002-36868 359:Intrapartum bleeding 353:Low arterial cord pH 280:Gestational diabetes 97:Abdominal ultrasound 33:Velamentous Placenta 16:Velamentous placenta 3703:Neonatal withdrawal 3686:Perinatal mortality 3536:Sclerema neonatorum 3392:hematologic disease 2915:Postpartum bleeding 2738:Placental abruption 2723:Monochorionic twins 2553:Prurigo gestationis 621:2013PLoSO...870380E 418:monochorionic twins 402:Fetal malformations 368:Placental abruption 356:Vascular thrombosis 132:is inserted in the 3636:mycoplasma hominis 3621:Neonatal infection 3577:Gray baby syndrome 3554:Perinatal asphyxia 3444:Hyperbilirubinemia 3221:Postterm pregnancy 3068:labour or delivery 2945:Puerperal mastitis 2900:Breast engorgement 2687:Monoamniotic twins 2677:Chorionic hematoma 2264:External resources 1742:10.1111/aogs.12666 1392:Prenatal Diagnosis 1240:Human Reproduction 978:10.1111/jmwh.12189 483:Systematic Reviews 250:Multiple gestation 180:Signs and symptoms 3716: 3715: 3604: 3603: 3454:Neonatal jaundice 3372:Pneumopericardium 3342:Pneumomediastinum 3283:Klumpke paralysis 3261:Caput succedaneum 3196: 3195: 3064:Maternal factors 3018: 3017: 2976:Thyroid disorders 2966:Diabetes mellitus 2850:Uterine inversion 2782:Shoulder dystocia 2777:Obstructed labour 2753: 2752: 2617: 2616: 2586:Chorea gravidarum 2362:Ectopic pregnancy 2287: 2286: 2126:10.1002/uog.18914 1499:(12): 1058–1064. 1246:(10): 2763–2767. 1150:10.1002/jum.14357 212:caesarean section 191:alpha-fetoprotein 119: 118: 106:Caesarean section 93:Diagnostic method 19:Medical condition 3736: 3696:Infant mortality 3531:Erythema toxicum 3523:thermoregulation 3490:Gastrointestinal 3298: 3297: 3294:Affected systems 3171: 3139: 3124:Chorioamnionitis 3117: 3088:Placenta praevia 3081: 3072: 3071: 3045: 3038: 3031: 3022: 3021: 3005: 3004: 2840:Postmature birth 2828:Placenta accreta 2733:Placenta praevia 2728:Placenta accreta 2672:Chorioamnionitis 2482:Digestive system 2478: 2477: 2404:Fetal resorption 2392:Rudimentary horn 2349:abortive outcome 2343: 2342: 2314: 2307: 2300: 2291: 2290: 2202: 2201: 2190: 2189: 2164:(1): e113–e117. 2153: 2147: 2146: 2128: 2104: 2098: 2097: 2095: 2071: 2065: 2064: 2054: 2022: 2016: 2015: 2003: 1997: 1996: 1960: 1949: 1948: 1912: 1906: 1905: 1887: 1885:10.1002/uog.2832 1863: 1854: 1853: 1817: 1811: 1810: 1774: 1763: 1762: 1744: 1720: 1709: 1708: 1671: 1665: 1664: 1628: 1622: 1621: 1584: 1573: 1572: 1536: 1527: 1526: 1516: 1484: 1478: 1477: 1467: 1443: 1424: 1423: 1387: 1376: 1375: 1357: 1333: 1324: 1323: 1287: 1276: 1275: 1265: 1255: 1231: 1220: 1219: 1183: 1170: 1169: 1133: 1100: 1099: 1089: 1065: 1028: 1027: 1025: 1001: 990: 989: 961: 924: 923: 894: 847: 846: 810: 793: 792: 756: 729: 728: 718: 694: 653: 652: 642: 632: 600: 519: 518: 508: 498: 474: 387:Low birth weight 253:Maternal smoking 67: 66: 42: 22: 21: 3744: 3743: 3739: 3738: 3737: 3735: 3734: 3733: 3719: 3718: 3717: 3712: 3669: 3653:Neonatal sepsis 3600: 3569:Musculoskeletal 3563: 3540: 3521: 3512: 3484: 3439:Hydrops fetalis 3390: 3381: 3358: 3331:Pleural disease 3289: 3251:Cephalohematoma 3230: 3192: 3165: 3160: 3133: 3128: 3107: 3102: 3075: 3067: 3065: 3059: 3049: 3019: 3014: 2992: 2949: 2893:Cracked nipples 2888:Low milk supply 2869: 2855:Uterine rupture 2749: 2644:Oligohydramnios 2629:amniotic cavity 2623: 2613: 2590: 2572: 2523: 2514: 2473: 2467: 2436: 2423: 2409:Molar pregnancy 2348: 2332: 2318: 2288: 2283: 2282: 2259: 2258: 2213: 2199: 2194: 2193: 2154: 2150: 2105: 2101: 2072: 2068: 2023: 2019: 2004: 2000: 1961: 1952: 1913: 1909: 1864: 1857: 1818: 1814: 1775: 1766: 1721: 1712: 1672: 1668: 1629: 1625: 1585: 1576: 1537: 1530: 1485: 1481: 1444: 1427: 1404:10.1002/pd.1753 1388: 1379: 1334: 1327: 1288: 1279: 1232: 1223: 1184: 1173: 1134: 1103: 1066: 1031: 1002: 993: 962: 927: 895: 850: 811: 796: 773:10.1002/uog.132 757: 732: 695: 656: 601: 522: 475: 440: 435: 426: 393:Low Apgar score 378: 341: 336: 316: 303: 297: 275:Type 1 diabetes 235: 199: 197:Pathophysiology 182: 142:Wharton's jelly 134:fetal membranes 61: 20: 17: 12: 11: 5: 3742: 3732: 3731: 3714: 3713: 3711: 3710: 3705: 3700: 3699: 3698: 3693: 3683: 3677: 3675: 3671: 3670: 3668: 3667: 3662: 3661: 3660: 3650: 3645: 3644: 3643: 3638: 3633: 3631:herpes simplex 3628: 3618: 3612: 3610: 3606: 3605: 3602: 3601: 3599: 3598: 3597: 3596: 3591: 3579: 3573: 3571: 3565: 3564: 3562: 3561: 3556: 3550: 3548: 3546:Nervous system 3542: 3541: 3539: 3538: 3533: 3527: 3525: 3514: 3513: 3511: 3510: 3505: 3500: 3494: 3492: 3486: 3485: 3483: 3482: 3477: 3476: 3475: 3465: 3459: 3458: 3457: 3456: 3451: 3441: 3436: 3435: 3434: 3429: 3424: 3419: 3414: 3403: 3402: 3396: 3394: 3383: 3382: 3380: 3379: 3374: 3368: 3366: 3364:Cardiovascular 3360: 3359: 3357: 3356: 3351: 3346: 3345: 3344: 3339: 3327: 3322: 3317: 3312: 3306: 3304: 3295: 3291: 3290: 3288: 3287: 3286: 3285: 3280: 3270: 3269: 3268: 3263: 3258: 3253: 3240: 3238: 3232: 3231: 3229: 3228: 3223: 3214: 3204: 3202: 3198: 3197: 3194: 3193: 3191: 3190: 3185: 3180: 3174: 3172: 3162: 3161: 3159: 3158: 3153: 3148: 3142: 3140: 3136:umbilical cord 3130: 3129: 3127: 3126: 3120: 3118: 3104: 3103: 3101: 3100: 3095: 3090: 3084: 3082: 3069: 3061: 3060: 3048: 3047: 3040: 3033: 3025: 3016: 3015: 3013: 3012: 2997: 2994: 2993: 2991: 2990: 2985: 2983:Maternal death 2980: 2979: 2978: 2973: 2968: 2957: 2955: 2951: 2950: 2948: 2947: 2942: 2937: 2932: 2927: 2922: 2917: 2912: 2907: 2902: 2897: 2896: 2895: 2890: 2879: 2877: 2871: 2870: 2868: 2867: 2862: 2857: 2852: 2847: 2842: 2837: 2832: 2831: 2830: 2818: 2813: 2812: 2811: 2801: 2796: 2791: 2789:Fetal distress 2786: 2785: 2784: 2774: 2769: 2763: 2761: 2755: 2754: 2751: 2750: 2748: 2747: 2746: 2745: 2740: 2735: 2730: 2725: 2720: 2708: 2707: 2706: 2696: 2695: 2694: 2689: 2684: 2679: 2674: 2658: 2653: 2652: 2651: 2649:Polyhydramnios 2646: 2638:amniotic fluid 2633: 2631: 2619: 2618: 2615: 2614: 2612: 2611: 2606: 2600: 2598: 2592: 2591: 2589: 2588: 2582: 2580: 2578:Nervous system 2574: 2573: 2571: 2570: 2565: 2560: 2555: 2550: 2545: 2540: 2535: 2529: 2527: 2516: 2515: 2513: 2512: 2507: 2502: 2497: 2492: 2486: 2484: 2475: 2469: 2468: 2466: 2465: 2460: 2459: 2458: 2456:HELLP syndrome 2448: 2442: 2440: 2425: 2424: 2422: 2421: 2416: 2411: 2406: 2401: 2396: 2395: 2394: 2389: 2384: 2379: 2374: 2369: 2359: 2353: 2351: 2347:Pregnancy with 2340: 2334: 2333: 2317: 2316: 2309: 2302: 2294: 2285: 2284: 2281: 2280: 2268: 2267: 2265: 2261: 2260: 2257: 2256: 2245: 2230: 2214: 2209: 2208: 2206: 2205:Classification 2198: 2197:External links 2195: 2192: 2191: 2148: 2119:(3): 378–384. 2099: 2066: 2037:(3): 360–367. 2017: 1998: 1971:(4): 409–412. 1950: 1907: 1878:(2): 126–136. 1855: 1828:(5): 975–981. 1812: 1785:(8): 963–968. 1764: 1735:(8): 878–883. 1710: 1683:(7): 437–441. 1666: 1639:(3): 209–213. 1623: 1574: 1547:(8): 451–460. 1528: 1479: 1458:(4): S70–S77. 1425: 1398:(7): 595–599. 1377: 1348:(6): 426–429. 1325: 1298:(8): 585–593. 1277: 1263:1854/LU-373160 1221: 1194:(3): 207–211. 1171: 1144:(2): 471–718. 1101: 1080:(2): 126–129. 1029: 991: 972:(3): 328–335. 925: 906:(2): 231–234. 848: 821:(2): 123–126. 794: 767:(6): 564–569. 730: 654: 520: 437: 436: 434: 431: 425: 422: 410: 409: 406: 405:Fetal bleeding 403: 400: 397: 394: 391: 388: 385: 382: 377: 374: 373: 372: 369: 366: 363: 360: 357: 354: 351: 350:Small placenta 348: 345: 340: 337: 335: 332: 315: 312: 302: 299: 295: 294: 291: 288: 285: 282: 277: 272: 266: 260: 254: 251: 248: 245: 242: 234: 231: 227:exsanguination 198: 195: 181: 178: 130:umbilical cord 117: 116: 113: 109: 108: 103: 99: 98: 95: 89: 88: 85: 79: 78: 75: 69: 68: 55: 49: 48: 44: 43: 35: 34: 31: 27: 26: 18: 15: 9: 6: 4: 3: 2: 3741: 3730: 3727: 3726: 3724: 3709: 3706: 3704: 3701: 3697: 3694: 3692: 3689: 3688: 3687: 3684: 3682: 3679: 3678: 3676: 3672: 3666: 3663: 3659: 3656: 3655: 3654: 3651: 3649: 3646: 3642: 3639: 3637: 3634: 3632: 3629: 3627: 3624: 3623: 3622: 3619: 3617: 3614: 3613: 3611: 3607: 3595: 3592: 3590: 3587: 3586: 3585: 3584: 3580: 3578: 3575: 3574: 3572: 3570: 3566: 3560: 3557: 3555: 3552: 3551: 3549: 3547: 3543: 3537: 3534: 3532: 3529: 3528: 3526: 3524: 3519: 3515: 3509: 3506: 3504: 3501: 3499: 3496: 3495: 3493: 3491: 3487: 3481: 3478: 3474: 3471: 3470: 3469: 3466: 3464: 3461: 3460: 3455: 3452: 3450: 3447: 3446: 3445: 3442: 3440: 3437: 3433: 3430: 3428: 3425: 3423: 3420: 3418: 3415: 3413: 3410: 3409: 3408: 3405: 3404: 3401: 3398: 3397: 3395: 3393: 3388: 3384: 3378: 3375: 3373: 3370: 3369: 3367: 3365: 3361: 3355: 3352: 3350: 3347: 3343: 3340: 3338: 3335: 3334: 3333: 3332: 3328: 3326: 3323: 3321: 3318: 3316: 3313: 3311: 3308: 3307: 3305: 3303: 3299: 3296: 3292: 3284: 3281: 3279: 3276: 3275: 3274: 3271: 3267: 3264: 3262: 3259: 3257: 3254: 3252: 3249: 3248: 3247: 3246: 3242: 3241: 3239: 3237: 3233: 3227: 3224: 3222: 3218: 3217:Preterm birth 3215: 3213: 3209: 3206: 3205: 3203: 3199: 3189: 3186: 3184: 3181: 3179: 3176: 3175: 3173: 3170: 3169: 3163: 3157: 3154: 3152: 3149: 3147: 3144: 3143: 3141: 3138: 3137: 3131: 3125: 3122: 3121: 3119: 3116: 3115: 3111: 3105: 3099: 3096: 3094: 3091: 3089: 3086: 3085: 3083: 3080: 3079: 3073: 3070: 3062: 3058: 3057:fetal disease 3054: 3046: 3041: 3039: 3034: 3032: 3027: 3026: 3023: 3011: 3010: 3006: 2999: 2998: 2995: 2989: 2986: 2984: 2981: 2977: 2974: 2972: 2969: 2967: 2964: 2963: 2962: 2959: 2958: 2956: 2952: 2946: 2943: 2941: 2938: 2936: 2933: 2931: 2928: 2926: 2923: 2921: 2918: 2916: 2913: 2911: 2908: 2906: 2903: 2901: 2898: 2894: 2891: 2889: 2886: 2885: 2884: 2881: 2880: 2878: 2876: 2872: 2866: 2865:Uterine atony 2863: 2861: 2858: 2856: 2853: 2851: 2848: 2846: 2843: 2841: 2838: 2836: 2835:Preterm birth 2833: 2829: 2826: 2825: 2824: 2823: 2819: 2817: 2814: 2810: 2807: 2806: 2805: 2802: 2800: 2797: 2795: 2792: 2790: 2787: 2783: 2780: 2779: 2778: 2775: 2773: 2770: 2768: 2765: 2764: 2762: 2760: 2756: 2744: 2741: 2739: 2736: 2734: 2731: 2729: 2726: 2724: 2721: 2719: 2716: 2715: 2714: 2713: 2709: 2705: 2702: 2701: 2700: 2697: 2693: 2690: 2688: 2685: 2683: 2680: 2678: 2675: 2673: 2670: 2669: 2668: 2667: 2663: 2659: 2657: 2654: 2650: 2647: 2645: 2642: 2641: 2640: 2639: 2635: 2634: 2632: 2630: 2626: 2620: 2610: 2607: 2605: 2602: 2601: 2599: 2597: 2593: 2587: 2584: 2583: 2581: 2579: 2575: 2569: 2568:Stretch marks 2566: 2564: 2561: 2559: 2556: 2554: 2551: 2549: 2546: 2544: 2541: 2539: 2536: 2534: 2531: 2530: 2528: 2526: 2521: 2517: 2511: 2508: 2506: 2503: 2501: 2498: 2496: 2493: 2491: 2488: 2487: 2485: 2483: 2479: 2476: 2470: 2464: 2461: 2457: 2454: 2453: 2452: 2451:Pre-eclampsia 2449: 2447: 2444: 2443: 2441: 2439: 2434: 2430: 2426: 2420: 2417: 2415: 2412: 2410: 2407: 2405: 2402: 2400: 2397: 2393: 2390: 2388: 2385: 2383: 2380: 2378: 2375: 2373: 2370: 2368: 2365: 2364: 2363: 2360: 2358: 2355: 2354: 2352: 2350: 2344: 2341: 2339: 2335: 2331: 2327: 2323: 2320:Pathology of 2315: 2310: 2308: 2303: 2301: 2296: 2295: 2292: 2279: 2275: 2274: 2270: 2269: 2266: 2262: 2255: 2251: 2250: 2246: 2244: 2240: 2239: 2235: 2231: 2229: 2225: 2224: 2220: 2216: 2215: 2212: 2207: 2203: 2187: 2183: 2179: 2175: 2171: 2167: 2163: 2159: 2152: 2144: 2140: 2136: 2132: 2127: 2122: 2118: 2114: 2110: 2103: 2094: 2089: 2085: 2081: 2077: 2070: 2062: 2058: 2053: 2048: 2044: 2040: 2036: 2032: 2028: 2021: 2013: 2009: 2002: 1994: 1990: 1986: 1982: 1978: 1974: 1970: 1966: 1959: 1957: 1955: 1946: 1942: 1938: 1934: 1930: 1926: 1922: 1918: 1911: 1903: 1899: 1895: 1891: 1886: 1881: 1877: 1873: 1869: 1862: 1860: 1851: 1847: 1843: 1839: 1835: 1831: 1827: 1823: 1816: 1808: 1804: 1800: 1796: 1792: 1788: 1784: 1780: 1773: 1771: 1769: 1760: 1756: 1752: 1748: 1743: 1738: 1734: 1730: 1726: 1719: 1717: 1715: 1706: 1702: 1698: 1694: 1690: 1686: 1682: 1678: 1670: 1662: 1658: 1654: 1650: 1646: 1642: 1638: 1634: 1627: 1619: 1615: 1611: 1607: 1603: 1599: 1595: 1591: 1583: 1581: 1579: 1570: 1566: 1562: 1558: 1554: 1550: 1546: 1542: 1535: 1533: 1524: 1520: 1515: 1510: 1506: 1502: 1498: 1494: 1490: 1483: 1475: 1471: 1466: 1461: 1457: 1453: 1449: 1442: 1440: 1438: 1436: 1434: 1432: 1430: 1421: 1417: 1413: 1409: 1405: 1401: 1397: 1393: 1386: 1384: 1382: 1373: 1369: 1365: 1361: 1356: 1351: 1347: 1343: 1339: 1332: 1330: 1321: 1317: 1313: 1309: 1305: 1301: 1297: 1293: 1286: 1284: 1282: 1273: 1269: 1264: 1259: 1254: 1249: 1245: 1241: 1237: 1230: 1228: 1226: 1217: 1213: 1209: 1205: 1201: 1197: 1193: 1189: 1182: 1180: 1178: 1176: 1167: 1163: 1159: 1155: 1151: 1147: 1143: 1139: 1132: 1130: 1128: 1126: 1124: 1122: 1120: 1118: 1116: 1114: 1112: 1110: 1108: 1106: 1097: 1093: 1088: 1083: 1079: 1075: 1071: 1064: 1062: 1060: 1058: 1056: 1054: 1052: 1050: 1048: 1046: 1044: 1042: 1040: 1038: 1036: 1034: 1024: 1019: 1015: 1011: 1007: 1000: 998: 996: 987: 983: 979: 975: 971: 967: 960: 958: 956: 954: 952: 950: 948: 946: 944: 942: 940: 938: 936: 934: 932: 930: 921: 917: 913: 909: 905: 901: 893: 891: 889: 887: 885: 883: 881: 879: 877: 875: 873: 871: 869: 867: 865: 863: 861: 859: 857: 855: 853: 844: 840: 836: 832: 828: 824: 820: 816: 809: 807: 805: 803: 801: 799: 790: 786: 782: 778: 774: 770: 766: 762: 755: 753: 751: 749: 747: 745: 743: 741: 739: 737: 735: 726: 722: 717: 712: 708: 704: 700: 693: 691: 689: 687: 685: 683: 681: 679: 677: 675: 673: 671: 669: 667: 665: 663: 661: 659: 650: 646: 641: 636: 631: 626: 622: 618: 615:(7): e70380. 614: 610: 606: 599: 597: 595: 593: 591: 589: 587: 585: 583: 581: 579: 577: 575: 573: 571: 569: 567: 565: 563: 561: 559: 557: 555: 553: 551: 549: 547: 545: 543: 541: 539: 537: 535: 533: 531: 529: 527: 525: 516: 512: 507: 502: 497: 492: 488: 484: 480: 473: 471: 469: 467: 465: 463: 461: 459: 457: 455: 453: 451: 449: 447: 445: 443: 438: 430: 421: 419: 415: 407: 404: 401: 398: 396:Fetal hypoxia 395: 392: 389: 386: 383: 380: 379: 370: 367: 364: 361: 358: 355: 352: 349: 346: 343: 342: 334:Complications 331: 327: 324: 320: 311: 307: 298: 292: 289: 286: 283: 281: 278: 276: 273: 271: 267: 265: 261: 259: 255: 252: 249: 246: 243: 240: 239: 238: 230: 228: 223: 221: 220:fetal hypoxia 215: 213: 207: 203: 194: 192: 188: 177: 174: 170: 166: 162: 157: 155: 151: 147: 143: 139: 135: 131: 127: 123: 114: 110: 107: 104: 100: 96: 94: 90: 86: 84: 80: 76: 74: 70: 65: 59: 56: 54: 50: 45: 41: 36: 32: 28: 23: 3581: 3462: 3337:Pneumothorax 3329: 3243: 3236:Birth trauma 3178:Breech birth 3168:presentation 3166: 3134: 3108: 3076: 3007: 3000: 2860:Vasa praevia 2820: 2794:Locked twins 2710: 2660: 2636: 2382:Interstitial 2271: 2247: 2232: 2217: 2161: 2157: 2151: 2116: 2112: 2102: 2083: 2079: 2069: 2034: 2030: 2020: 2011: 2007: 2001: 1968: 1964: 1920: 1916: 1910: 1875: 1871: 1825: 1821: 1815: 1782: 1778: 1732: 1728: 1680: 1676: 1669: 1636: 1632: 1626: 1596:(1): 35–39. 1593: 1589: 1544: 1540: 1496: 1492: 1482: 1455: 1451: 1395: 1391: 1345: 1341: 1295: 1291: 1243: 1239: 1191: 1187: 1141: 1137: 1077: 1073: 1013: 1009: 969: 965: 903: 899: 818: 814: 764: 760: 709:(1): 21–25. 706: 702: 612: 608: 486: 482: 427: 424:Epidemiology 411: 328: 325: 321: 317: 308: 304: 296: 270:hypertension 236: 233:Risk factors 224: 216: 208: 204: 200: 183: 158: 152:towards the 138:amniotic sac 121: 120: 83:Risk factors 3681:Miscarriage 3583:muscle tone 3449:Kernicterus 3302:Respiratory 3278:Erb's palsy 3183:Asynclitism 3151:Nuchal cord 2799:Nuchal cord 2548:Linea nigra 2500:Hepatitis E 2433:proteinuria 2414:Miscarriage 2399:Embryo loss 2377:Heterotopic 2014:(2): 75–88. 1016:(3): e313. 381:Prematurity 344:Vasa previa 241:Nulliparity 169:vasa previa 30:Other names 3691:Stillbirth 3648:Omphalitis 3609:Infections 3518:Integument 2809:Postpartum 2704:Antepartum 2419:Stillbirth 2330:puerperium 2328:, and the 2326:childbirth 2249:DiseasesDB 2158:Pediatrics 2086:(1): S20. 1923:(5): 574. 489:(1): 242. 433:References 314:Management 165:ultrasound 128:where the 58:Obstetrics 3417:Anti-Kell 3055:period / 3053:perinatal 2875:Puerperal 2463:Eclampsia 2367:Abdominal 2338:Pregnancy 2322:pregnancy 2273:eMedicine 1569:259998340 301:Diagnosis 262:Maternal 256:Maternal 126:pregnancy 112:Frequency 102:Treatment 53:Specialty 3723:Category 3387:Bleeding 3078:placenta 3009:Category 2822:placenta 2712:placenta 2372:Cervical 2357:Abortion 2278:med/3276 2186:19061448 2178:16361224 2143:10906198 2135:28976606 2061:25758620 1985:24758363 1945:36906136 1937:12963533 1902:25954526 1894:16826560 1842:26498602 1807:43165100 1799:16870889 1759:45614777 1751:25943426 1705:45427947 1661:74179289 1618:11157923 1610:19215545 1561:12541219 1523:19879649 1493:Placenta 1474:26428505 1420:37634607 1412:17497747 1372:35261375 1320:40093577 1272:17720701 1216:23409481 1166:26888548 1158:28850682 1096:27453740 986:24751147 920:22944380 843:39286973 781:12808673 725:17272203 649:23936197 609:PLOS ONE 515:29208042 339:Maternal 268:Chronic 154:placenta 148:and the 73:Symptoms 3626:rubella 3256:Chignon 3110:chorion 2662:chorion 2387:Ovarian 2052:5703063 1993:1390065 1850:1011746 1697:8960614 1653:8630303 1514:2790011 1364:9918092 1312:8839406 1208:6148278 1087:4863500 835:1590867 789:1788491 640:3728211 617:Bibcode 506:5718132 264:obesity 150:chorion 3201:Growth 3114:amnion 2666:amnion 2184:  2176:  2141:  2133:  2059:  2049:  1991:  1983:  1943:  1935:  1900:  1892:  1848:  1840:  1805:  1797:  1757:  1749:  1703:  1695:  1659:  1651:  1616:  1608:  1567:  1559:  1521:  1511:  1472:  1418:  1410:  1370:  1362:  1318:  1310:  1270:  1214:  1206:  1164:  1156:  1094:  1084:  984:  918:  841:  833:  787:  779:  723:  647:  637:  513:  503:  258:asthma 173:cervix 146:amnion 60:  3674:Other 3498:Ileus 3245:scalp 2954:Other 2759:Labor 2625:fetus 2596:Blood 2435:, and 2429:Edema 2254:34591 2243:762.6 2228:O43.1 2182:S2CID 2139:S2CID 1989:S2CID 1941:S2CID 1898:S2CID 1846:S2CID 1803:S2CID 1755:S2CID 1701:S2CID 1657:S2CID 1614:S2CID 1565:S2CID 1416:S2CID 1368:S2CID 1316:S2CID 1212:S2CID 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2033:. 2029:. 2012:21 2010:. 1987:. 1979:. 1969:28 1967:. 1953:^ 1939:. 1931:. 1921:23 1919:. 1896:. 1888:. 1876:28 1874:. 1870:. 1858:^ 1844:. 1836:. 1824:. 1801:. 1793:. 1783:25 1781:. 1767:^ 1753:. 1745:. 1733:94 1731:. 1727:. 1713:^ 1699:. 1691:. 1681:13 1679:. 1655:. 1647:. 1635:. 1612:. 1604:. 1594:35 1592:. 1577:^ 1563:. 1555:. 1545:19 1543:. 1531:^ 1517:. 1507:. 1497:30 1495:. 1491:. 1468:. 1454:. 1450:. 1428:^ 1414:. 1406:. 1396:27 1394:. 1380:^ 1366:. 1358:. 1346:12 1344:. 1340:. 1328:^ 1314:. 1306:. 1296:15 1294:. 1280:^ 1266:. 1256:. 1244:22 1242:. 1238:. 1224:^ 1210:. 1202:. 1192:22 1190:. 1174:^ 1160:. 1152:. 1142:37 1140:. 1104:^ 1090:. 1076:. 1072:. 1032:^ 1012:. 1008:. 994:^ 980:. 970:59 968:. 928:^ 914:. 902:. 851:^ 837:. 829:. 817:. 797:^ 783:. 775:. 765:21 763:. 733:^ 719:. 707:45 705:. 701:. 657:^ 643:. 633:. 623:. 611:. 607:. 523:^ 509:. 499:. 485:. 481:. 441:^ 214:. 3112:/ 3044:e 3037:t 3030:v 2522:/ 2313:e 2306:t 2299:v 2236:- 2221:- 2211:D 2188:. 2168:: 2145:. 2123:: 2096:. 2090:: 2063:. 2041:: 1995:. 1975:: 1947:. 1927:: 1904:. 1882:: 1852:. 1832:: 1809:. 1789:: 1761:. 1739:: 1707:. 1687:: 1663:. 1643:: 1620:. 1600:: 1571:. 1551:: 1525:. 1503:: 1476:. 1462:: 1422:. 1402:: 1374:. 1352:: 1322:. 1302:: 1274:. 1260:: 1250:: 1218:. 1198:: 1168:. 1148:: 1098:. 1078:9 1026:. 1020:: 988:. 976:: 922:. 910:: 845:. 825:: 819:9 791:. 771:: 727:. 713:: 651:. 627:: 619:: 613:8 517:. 493:: 487:6

Index

Velamentous Cord insertion
Specialty
Obstetrics
Edit this on Wikidata
Symptoms
Risk factors
Diagnostic method
Caesarean section
pregnancy
umbilical cord
fetal membranes
amniotic sac
Wharton's jelly
amnion
chorion
placenta
assisted reproductive technology
ultrasound
vasa previa
cervix
human chorionic gonadotropin
alpha-fetoprotein
caesarean section
fetal hypoxia
exsanguination
asthma
obesity
hypertension
Type 1 diabetes
Gestational diabetes

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