Clinical Significance of Pregnancies Complicated by Velamentous Umbilical Cord Insertion 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.