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Revue Medicale de Liege Jan 2020Velamentous cord insertion is a rare placental abnormality, that may be associated with vasa praevia, i.e. the presence of an umbilical vessel near the internal cervical...
Velamentous cord insertion is a rare placental abnormality, that may be associated with vasa praevia, i.e. the presence of an umbilical vessel near the internal cervical orifice. In case of spontaneous rupture of the membranes, there is a major risk of fetal haemorrhage, which is often lethal for the unborn baby. The challenge of care is based on the prenatal diagnosis during the 2nd trimester ultrasound. In case a vasa praevia is confirmed during the 3rd trimester, elective caesarean section should be carried out prior to the onset of labour, between 34 and 36 weeks of pregnancy. Corticosteroid treatment for fetal lung maturation is recommended at 32 weeks of gestation because of the increased risk of preterm delivery. Velamentous cord insertion may be associated with other adverse pregnancy outcomes such as intrauterine growth restriction, death in utero, placental abnormalities.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Prenatal Diagnosis; Ultrasonography, Prenatal; Vasa Previa
PubMed: 31920037
DOI: No ID Found -
Cureus Mar 2023Vaginal bleeding in the second and third trimesters of pregnancy is usually due to placental causes, namely placental abruption and placenta previa. Other causes include...
Vaginal bleeding in the second and third trimesters of pregnancy is usually due to placental causes, namely placental abruption and placenta previa. Other causes include uterine rupture, vasa previa, and hematologic disorders. However, benign or malignant lesions of the vagina and the cervix may also cause vaginal bleeding or spotting. Although cervical cancer in pregnancy is rare, about 8% of pregnant women have an abnormal Pap smear and 3% of the total cervical cancers are diagnosed during pregnancy. We report a case of a 20-week pregnant woman who presented with vaginal bleeding; a visual inspection revealed a large exophytic lesion of the cervix. The Pap smear demonstrated a low-grade squamous intraepithelial lesion (LSIL) related to human papillomavirus (HPV) infection. The differential diagnosis based on the findings of the colposcopy included invasive cervical carcinoma, warty lesions, and perishable lesion. A cesarean section and the removal of the cervical tumor were scheduled and carried out as planned at 37 weeks of gestation. The histologic examination showed extensive lesions of low-grade squamous intraepithelial cervical neoplasia (LSIL/CIN1). Despite the fact that exophytic tumors of the cervix are extremely rare, in women presenting with vaginal bleeding or spotting during the second or third trimester of pregnancy, the ultrasound scan must be followed by a visual inspection of the vagina and the cervix.
PubMed: 37020479
DOI: 10.7759/cureus.35747 -
European Journal of Obstetrics,... Jul 2024Congenital anomalies of the umbilical cord are associated with an increased risk of pregnancy and perinatal complications. Some anomalies of the cord have a higher...
Congenital anomalies of the umbilical cord are associated with an increased risk of pregnancy and perinatal complications. Some anomalies of the cord have a higher prevalence than other fetal structural anomalies. The most common anomalies are the absence of an umbilical artery and velamentous insertion of the cord (with or without vasa previa). These anomalies, even when not associated with fetal structural defects, increase the risk of adverse perinatal outcome including, fetal growth restriction and stillbirth. In the absence of prenatal diagnosis, vasa previa is associated with the highest perinatal morbidity and mortality of all congenital anomalies of the umbilical cord. Most cases can be detected by ultrasound from the beginning of the second trimester and should be included in the routine mid-pregnancy ultrasound examination. Documentation should include cord insertion site, number of vessels in the cord, and if other pathologies have been detected. Pregnancies at increased risk of velamentous cord insertion should be screened for vasa previa using transvaginal ultrasound and colour Doppler imaging. If a velamentous cord insertion or isolated single umbilical artery is detected, individualised follow-up during pregnancy and tailored obstetric management are indicated.
Topics: Humans; Female; Umbilical Cord; Pregnancy; Ultrasonography, Prenatal; Vasa Previa; Umbilical Arteries; Europe
PubMed: 38728843
DOI: 10.1016/j.ejogrb.2024.04.044 -
American Journal of Obstetrics and... Sep 2017It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those...
Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology.
BACKGROUND
It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously.
OBJECTIVE
We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis.
STUDY DESIGN
All twin live births of ≥22 weeks' gestation and ≥350 g birthweight to Massachusetts resident women in 2004 through 2010 were linked to hospital discharge records, vital records, and in vitro fertilization cycles. Women were categorized by their fertility status as in vitro fertilization, subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to in vitro fertilization cycles were classified as in vitro fertilization; those with indicators of subfertility but without in vitro fertilization treatment were classified as subfertile; all others were classified as fertile. Risks of 6 adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications [placenta abruptio, placenta previa, and vasa previa], prenatal hospitalizations, and primary cesarean) and 9 adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm [<32 weeks], preterm, birth defects, neonatal death, and infant death) were modeled by fertility status with the fertile group as reference, using multivariate log binomial regression and reported as adjusted relative risk ratios and 95% confidence intervals.
RESULTS
The study population included 10,352 women with twin pregnancies (6090 fertile, 724 subfertile, and 3538 in vitro fertilization). Among all twins, the risks for all 6 adverse pregnancy outcomes were significantly increased for the subfertile and in vitro fertilization groups, with highest risks for uterine bleeding (adjusted relative risk ratios, 1.92 and 2.58, respectively) and placental complications (adjusted relative risk ratios, 2.07 and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth and neonatal and infant death (adjusted relative risk ratios, 1.36, 1.89, and 1.87, respectively). Risks were significantly increased among in vitro fertilization twins for very preterm birth, preterm birth, and birth defects (adjusted relative risk ratios, 1.28, 1.07, and 1.26, respectively).
CONCLUSION
Risks of all maternal and most infant adverse outcomes were increased for subfertile and in vitro fertilization twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and in vitro fertilization groups, and neonatal and infant death in the subfertile group. These findings provide further evidence supporting single embryo transfer and more cautious use of ovulation induction.
Topics: Adult; Breech Presentation; Cesarean Section; Congenital Abnormalities; Female; Fertilization in Vitro; Humans; Infant, Low Birth Weight; Infertility; Male; Massachusetts; Placenta Diseases; Pregnancy; Pregnancy, Twin; Premature Birth; Single Embryo Transfer; Uterine Hemorrhage
PubMed: 28455086
DOI: 10.1016/j.ajog.2017.04.025 -
Journal of Clinical Medicine Research Nov 2015We examined the clinical significance of pregnancies complicated by velamentous cord insertion (VCI) associated with other umbilical cord/placental abnormalities.
BACKGROUND
We examined the clinical significance of pregnancies complicated by velamentous cord insertion (VCI) associated with other umbilical cord/placental abnormalities.
METHODS
Data were collected from 168 deliveries complicated by VCI and from 16,797 unaffected controls. All placentae were screened identically by trained staff. In this study, we examined the presence of excessively long umbilical cord (longer than 70 cm), vasa previa, single umbilical artery, circumvallate placenta, succenturiate placenta, lobed placenta, placenta previa, low lying placenta and placenta accrete as the other umbilical cord/placental abnormalities.
RESULTS
Using a multivariate analysis, the pregnancies complicated by VCI were independently associated with in vitro fertilization use (P < 0.01), maternal smoking (P = 0.03), preterm delivery (P = 0.03), fetal asphyxia (P = 0.01) and small-for-gestational-age infants (P = 0.02). It was also independently associated with vasa previa (P < 0.01), single umbilical artery (P = 0.04), lobed placenta (P = 0.01) and placenta previa (P = 0.03). However, these umbilical cord/placental abnormalities were not associated with the further adverse outcomes of the pregnancies complicated by VCI.
CONCLUSION
VCI is associated with an increased risk of adverse perinatal outcomes irrespective of the presence of other umbilical cord/placental abnormalities. Routine identification of the placental cord insertion site should be considered.
PubMed: 26491497
DOI: 10.14740/jocmr2310w -
BMJ Case Reports Apr 2021Umbilical cord rupture (UCR) in utero is a very rare and critical emergency that can cause fetal death within minutes. A 38-year-old nulliparous woman was admitted at 39...
Umbilical cord rupture (UCR) in utero is a very rare and critical emergency that can cause fetal death within minutes. A 38-year-old nulliparous woman was admitted at 39 weeks in labour. Sudden watery vaginal discharge and bleeding with a rapid drop in the fetal heart rate to 60 beats/min necessitated an emergency caesarean section. A male infant weighing 2632 g was delivered 21 min after the onset of bradycardia; Apgar scores were 0 and 1 at 1 and 5 min, respectively. He was extremely pale; the umbilical arterial blood pH was 6.89 and haemoglobin was 9.0 g/dL. The umbilical cord had a velamentous insertion and was lacerated, with haemorrhage in the outer layer of an umbilical artery close to the placental end. The presentation was typical of UCR: vaginal bleeding following the rupture of membranes. Prompt diagnosis of UCR and termination of pregnancy are essential for fetal survival.
Topics: Adult; Cesarean Section; Female; Fetal Blood; Fetus; Humans; Male; Pregnancy; Umbilical Cord; Vasa Previa
PubMed: 33875500
DOI: 10.1136/bcr-2020-240245 -
Journal de Gynecologie, Obstetrique Et... Oct 2013Vasa previa is a rare complication of pregnancy (1/2000 to 1/6000) with a high fetal mortality rate (75 to 100%). We will discuss two case reports of vasa previa: the...
Vasa previa is a rare complication of pregnancy (1/2000 to 1/6000) with a high fetal mortality rate (75 to 100%). We will discuss two case reports of vasa previa: the first was diagnosed before labor, while the second was during delivery. In the first case, the diagnosis of vasa previa was confirmed by a transvaginal ultrasound and color doppler, while the second case involved late diagnosis during delivery and after gross examination of the placenta. Risk factors for vasa previa are: low-lying placenta, bilobed or succenturiate lobed placenta, velamentous and in vitro fertilization (IVF). Antenatal diagnosis of vasa previa is crucial because it allows for prophylactic caesarean section and prevents severe Benckiser's hemorrhage responsible for a very high neonatal mortality.
Topics: Adult; Cesarean Section; Delivery, Obstetric; Female; Fertilization in Vitro; Hemorrhage; Humans; Infant, Newborn; Placenta; Pregnancy; Prenatal Diagnosis; Prognosis; Risk Factors; Ultrasonography, Prenatal; Vasa Previa
PubMed: 23287072
DOI: 10.1016/j.jgyn.2012.11.011 -
International Journal of Gynaecology... Dec 1996To evaluate different alkaline denaturation tests and compare with hemoglobin electrophoresis and the Kleihauer test, and to identify the simplest and most sensitive...
OBJECTIVES
To evaluate different alkaline denaturation tests and compare with hemoglobin electrophoresis and the Kleihauer test, and to identify the simplest and most sensitive test that may help to rapidly show the presence of fetal hemoglobin and establish the diagnosis of fetal bleeding from vasa previa.
METHODS
Maternal and fetal cord blood were obtained from 20 women with uncomplicated deliveries and the samples were mixed in known concentrations ranging from 0-100% fetal blood. Further samples were prepared in which maternal and fetal blood mixtures were diluted with amniotic fluid so that the final concentration of fetal hemoglobin similarly ranged from 0-100%. Alkaline denaturation tests (Apt, Ogita, Loendersloot), hemoglobin electrophoresis and Kleihauer tests were performed on all 40 samples.
RESULTS
The Apt and Loendersloot tests were clearly positive at 60% concentrations of fetal blood. It took approximately 7 and 4 min, respectively, to complete the tests. The Ogita test was positive from fetal blood concentrations of 20% and took approximately 5 min. Hemoglobin electrophoresis took approximately 1 h to complete and the Hb-F band was present even at 0% concentration of fetal blood and the band became more marked with increasing fetal blood concentration. The Kleihauer test was negative at 0% but positive from 0.01% fetal blood concentration. The test took approximately 45 min to perform.
CONCLUSIONS
The Ogita test is the best all round alkaline denaturation test that may help to rapidly identify the presence of fetal hemoglobin and so establish the need to expedite delivery when there is fetal bleeding from vasa previa. It is simple to perform, does not require sophisticated equipment, unlikely to give false positive results, and takes only 5 min. The simplicity of the test makes it attractive for routine use on the labor ward.
Topics: Electrophoresis; Evaluation Studies as Topic; Female; Fetal Blood; Hemorrhage; Humans; Obstetrics; Placenta Previa; Pregnancy; Sensitivity and Specificity; Umbilical Arteries
PubMed: 9003944
DOI: 10.1016/s0020-7292(96)02746-4 -
Journal de Gynecologie, Obstetrique Et... Sep 2006Benckiser's hemorrhage is a rare affection associated with 75-100% neonatal mortality. It is due to the rupture of one or more velamentous and previa vessels. We report...
Benckiser's hemorrhage is a rare affection associated with 75-100% neonatal mortality. It is due to the rupture of one or more velamentous and previa vessels. We report two cases, one of which was fatal for the child despite immediate neonatal management. This illustrates how difficult the obstetrical and neonatal management of this affection is. Risk factors for velamentous insertion of the cord and vasa previa are multiple pregnancies, low lying placenta, bilobed and succenturiate-lobed placenta. First we specify the pathophyisiological implication of this severe hemorrhage, then the means to diagnose fetal bleeding or vasa previa. This knowledge could allow us to develop strategies to screen women sonographically to detect vasa previa. Unfortunately the benefits, risks, limits and cost of such strategies remain unknown.
Topics: Adult; Fatal Outcome; Female; Hemorrhage; Humans; Placenta; Pregnancy; Rupture, Spontaneous; Umbilical Arteries; Umbilical Veins
PubMed: 16940923
DOI: 10.1016/s0368-2315(06)76427-4 -
Ultrasound in Obstetrics & Gynecology :... Sep 2000To describe three-dimensional (3D) ultrasonography (US) for the antepartum diagnosis of vasa previa.
OBJECTIVE
To describe three-dimensional (3D) ultrasonography (US) for the antepartum diagnosis of vasa previa.
DESIGN
This was a descriptive study of two pregnant women who were suspected to have vasa previa by conventional gray-scale ultrasonography. Three-dimensional studies were also performed during the early third trimester to further investigate the possibility of this condition.
RESULTS
In the first case, 3D US provided gray-scale multiplanar and surface-rendered views of an aberrant vessel over the internal cervical os. For the second case, a 'flight-path' technique allowed the examiner to follow axial views of the endocervical canal toward the internal os until an aberrant vessel was verified. The 'niche-mode' analysis, with and without color power Doppler ultrasonography, was also used to confirm the diagnosis.
CONCLUSION
Three-dimensional ultrasonography offers several additional imaging tools that are not currently provided by more conventional ultrasonography for the detection of vasa previa. It represents an important adjunct to two-dimensional (2D) studies, especially when this diagnosis is questionable.
Topics: Adult; Female; Fetus; Humans; Placenta; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Trimester, Third; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Vagina
PubMed: 11169317
DOI: 10.1046/j.1469-0705.2000.00188.x