Velamentous cord insertion
Under a Insertio velamentosa is understood in obstetrics, a recognition inconsistency of the umbilical cord, in which the vessels run freely across the fetal membranes. It stands in contrast to the physiological, directly on the placenta accreting umbilical cord insertions.
Epidemiology
With an incidence of approximately one percent of all singleton pregnancies is in the Insertio velamentosa a relatively rare anomaly occurring. The probability increases as part of a multiple pregnancy. The diagnosis is usually made as an incidental finding after the birth of the placenta and in most cases before the onset of membrane rupture recognizable.
Possible complications
Due to the unprotected course of the umbilical cord vessels may occur at an early stage of pregnancy by compressions and an associated reduced blood supply to non -related chromosomal malformations of the child. In the further course of pregnancy may be a lack of development can be established. Towards the end of pregnancy and during birth can cause an oxygen deficiency of the child a compressed vessel. The risk is especially increased when the vessels are near the cervix. A rupture can in rare cases lead to the violation of one or more of these vessels, which have a strong result in bleeding depending on the degree. Since this is only the blood of the child, there is a danger to life for the unborn child by exsanguination.
Symptoms
During the vaginal examination pulsating vessels can be palpated on the fetal membranes in the cervix open. With the onset of membrane rupture occurs vaginal bleeding, the CTG shows significant decelerations of the fetal heart frequency. The circulatory status of the mother, however, remains stable.
Therapy
The urgency of bleeding complications after successful vascular injury requires immediate delivery. If the birth in deep standing head just before, this can be accelerated by using a vaginal surgical procedure such as vacuum extraction or forceps. In all other cases, a moderate emergency Caesarean section is indicated in still living child. Depending on the blood loss of the child intensive care and blood transfusions are necessary.
Forecast
When a vessel tear with subsequent severe bleeding, the prognosis for the child is classified as very unfavorable. If the insertions velamentosa diagnosed by incidental finding after an uncomplicated birth, the child is not expected to damage to health in general. The probability that this anomaly is repeated in subsequent pregnancies, is extremely low.
Source
- Willibald Pschyrembel ( Lim. ), Joachim Dudenhausen (Ed. ): Pschyrembel. Practical Obstetrics. Walter de Gruyter, Berlin 2008, ISBN 978-3-11-019074-8.
- Obstetrics and Gynecology