Velamentous Cord Insertion With Vaginal Delivery: A Case Report and Review of the Literature

TL;DR

A case study shows that vaginal delivery can be safe for pregnancies with a rare umbilical cord abnormality when closely monitored.

Contribution

This case report adds to the evidence that vaginal delivery is a feasible option for velamentous cord insertion with proper monitoring.

Findings

A 28-year-old woman successfully delivered vaginally with vacuum assistance despite velamentous cord insertion.

Postnatal examination confirmed the cord's velamentous attachment with no complications for mother or newborn.

The case supports the possibility of vaginal delivery when accompanied by prenatal evaluation and continuous monitoring.

Abstract

Velamentous cord insertion (VCI) is a rare placental abnormality in which the umbilical cord enters the chorionic membranes instead of the placenta, leaving the umbilical vessels unprotected. This pathological condition carries an increased risk of adverse perinatal outcomes, such as fetal growth restriction, preterm delivery, abnormal fetal heart rate patterns during labor, and perinatal morbidity, which often lead healthcare professionals to choose cesarean section to reduce postnatal risks. Early prenatal diagnosis using color Doppler imaging and comprehensive ultrasound is of utmost importance for proper risk assessment and birth planning. This case study presents a 28-year-old woman in whom screening for abnormalities during the second trimester of pregnancy detected a prenatally detected velamentous umbilical cord insertion. The pregnancy was closely monitored, and the patient chose vaginal delivery despite the multidisciplinary team's recommendations for a cesarean section, with continuous intrauterine monitoring of the fetus. At 38 weeks of gestation, a successful vaginal delivery was performed with vacuum assistance, without complications for the pregnant woman or the newborn. A postnatal examination of the placenta revealed velamentous attachment of the umbilical cord, and both the mother and the newborn recovered without complications. In pregnancies complicated by velamentous umbilical cord insertion, vaginal delivery may be a safe and feasible option when accompanied by appropriate prenatal evaluation and continuous intrauterine monitoring. These findings are supported by other case studies following a comprehensive review of the existing literature. Instead of preferring cesarean section, individualized obstetric care can improve outcomes while respecting the mother's preferences. However, further extensive research is needed to develop evidence-based guidelines on the best methods of delivery for such pregnancies.

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