VCI questions

[Texasminx]

My dear sweet pea just turned 6 months old in Jan. He was born at 37wks with a VCI placenta. I had never heard or read of this. I was told that this was unusual in singleton p.g.'s. I had been in a serious car accident when I was just a few weeks p.g. and was wondering if this could have caused it? He was my fifth child and I had never had any problems with any of my other children's births and just found it very odd and coincidental that I did with this guy. After the acccident the dr. had me on meds, most I don't remember with the exception of Vioxx. He turned out perfect and the only reason that the OB checked me with the monitor was that I told her something wasn't right. She asked me if he was moving ok, I said yea, but something isn't right, so I just find it odd that nothing showed up at the 18 wk u.s. since it was one of those that show the color and such. Also, could the car accident have jarred the newly settled placenta causing it to shift down? I was so struck by the odditiy of the placenta that I had my husband take pictures of it. The hospital then asked if they could keep it to show to the nurses and others as a training tool or something. Little bit foggy on all of that now. Have ya'll seen this before? and how often? What is the general cause and outcome? I am blessed that my baby was healthy, but I am hesitant to have anymore since having this wrong with this last p.g.
Lou

[doctorjen]

Are you talking about a velamentous cord insertion? I'm not sure of your abbrieviation, but that's my guess?
I've seen 2, both attached to healthy, postdates babies. The last one was just 2 weeks ago.
It is generally not picked up on ultrasound since it's hard to trace the cord all the way to its insertion site.
I was really glad at both births that I didn't go rupturing membranes early on, since there is a real risk of hooking a vessel, or a vessel shearing from the membranes being ruptured. It is unlikely a cesarean could even be performed quickly enough to save the baby if a vessel was torn open.
According to Williams Obstetrics, it occurs in 1% of singleton gestations, more frequently for twins, and is pretty much the normal for at least one cord insertion in a triplet or higher order placenta.

[doctorjen]

Forgot your questions!
I don't think there is any known cause of velamentous insertion - I don't think your accident or meds caused it. I don't believe there is any particular risk for it to recur, either.
It is most often discovered after delivery, and doesn't usually cause any problems during labor, unless a vessel is sheared or torn. Occasionally, the vessels, which are not protected by the cord, can be compressed during contractions and cause fetal distress. Vasa previa occurs when the vessels running through the membranes are in front of the baby, causing a risk of those vessels either rupturing or being compressed by the baby during labor.
Both births I've attended with velamentous insertion had normal healthy babies born vaginally. The only problem I encountered was having to do a manual removal of the placenta with the second mom because I applied cord traction in an attempt to deliver the placenta quickly because the mom was bleeding heavily (she had a dense epidural and no feeling of contractions or pressure to help her spontaneously birth the placenta.) I avulsed the cord from the placenta and the mom started to bleed even heavier, so I had to go after the placenta. Won't be pulling on any more cords, believe me!

[Texasminx]

Originally Posted by doctorjen

Are you talking about a velamentous cord insertion? I'm not sure of your abbrieviation, but that's my guess?
I've seen 2, both attached to healthy, postdates babies. The last one was just 2 weeks ago.

Yes, that is exactly what the abbreviation was referring to. by postdate I am assuming that you are referencing overdue babies? Just curious as to how "normal" things were in my p.g. vs. theirs as far as signs go. Was there any changes in the heart rates (substantial drops) that would have indicated beforehand that there were any problems? The reason why I ask this is that I didn't "feel" right during this last pregnancy and during all the others I had been extremely comfortable, but this last one I had trouble laying in certain positions as if I was suffocating the baby. Sounds weird, I know, but that was how it felt to me and during the early part of my pregnancy slept only on my right side and during the last trimester I moved constantly at night to avoid this suffocating feeling. Were the women that you seen more uncomfortable about their VCI p.g.'s? A lot of questions, I know. I just dont' know if this pregnancy was the result of something I did (i.e. accident, physical therapy, etc.) and if future pregnancies would have a similar result or?

[doctorjen]

Nope, both moms had normal, comfortable pregnancies. The second one was a teenager, who had terrible hyperemesis early in pregnancy, but otherwise did well. Both went into labor on their own, and normal fetal heart rates during labor, and normal births with healthy babies.
I don't believe anything is known to cause velamentous insertion, and it isn't likely to happen again.

[xenomama]

Ok, I'm lost. What does velamentous insertion mean? Are the vessels on the outside of the cord?

[doctorjen]

Velamentous insertion of the cord is when instead of the cord inserting directly into the placenta, the cord stops and the vessels run directly through the membranes for a while before joining the placenta. It is potentially dangerous because the cord normally protects and cushions the blood vessels. The vessels running through the membranes are unprotected and can be compressed more easily. Also, there is always the risk of the vessels shearing or tearing when the membranes rupture (even spontaneously, but more risky with artificial rupture of membranes) Sometimes, the vessels running through the membranes can be in front of baby's head, known as vasa previa. They are then compressed with every contraction, and can rupture and the baby can bleed to death very quickly.

[Texasminx]

I actually had my husband snap some photos of it. I didn't really know why at the time, just that I wanted to look at it more closely when I wasn't so tired and could concentrate on it. I am glad that I did as I occaisionally do go back and look at it just to observe and it thank God that my baby was healthy.

[cbparis5]

Hi! I am Secretary of the International Vasa Previa Foundation. Velamentous cord insertion occurs once or twice in every 100 pregnancies. The current thinking is that it develops from a low lying placenta. As a low lying placenta remodels ("moves") its way up it can form lobes and/or leave exposed fetal umbilical vessels behind. This theory is called Trophotropism. The easiest way to explain this is to make a comparison to a plant. A plant will lean towards the sun to get the light it needs to survive. Since the lower segment of the uterus is not as nourishing as the upper segment, the placenta will grow to reach more nourishing tissue. The placental mass may erode and the new growth may occur away from the location where the cord inserts. It can also leave velamentous vessels connecting the lobes.

After my baby had this (1996) I was told it was statistically impossible to have it again. But in my work I have seen that it occasionally does. Typically women are told now that they have about the same chance of having it again as they had the first time. There are pictures of my son's velamentous cord insertion at http://NathanParis.com/vp.htm

Cindy Paris
Mum to Nathan Elliot Paris ^i^
http://NathanParis.com

and Secretary
International Vasa Previa Foundation
http://www.vasaprevia.org

Risk Factors, Testing, and IVPF Management Recommendations for Vasa Previa:
http://www.vasaprevia.org/education/recommendations.htm

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Medical Resources on Vasa Previa
http://www.vasaprevia.org/resources/resources.htm

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online - http://www.vasaprevia.org/Docs/IVPFslideshow.htm

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Save babies from an untimely death due to vasa previa by JOINING the International Vasa Previa Foundation, Inc. as a participating member!
---
Visit http://www.vasaprevia.org to learn about vasa previa. It only takes a moment to diagnose life...

[Tattoomom]

My second child was born vaginally at 37 weeks. I had arrived at labor and delivery with a high fever, dilated and thinning. My doctor decided it was best to deliver early, when the baby's heart rate would not decrease, probably due to my fever.

It was an induced labor, using pitocin AND artificial rupture of membranes. After receiving an epidural, my labor and delivery went fairly quick. After a few hours and a few pushes, I delivered a baby girl!

However, my midwife realized after the birth that the baby had a velamentous inserted cord. It was not detected in uteruo through ultrasound.

Ironically, my first child, born 2 years previous, had a very short umbilical cord, that also was not detected until after the birth. His delivery was very hard and long and ended with forcepts. I personally think his cord was stretched to the max to get him out and the doctor didn't realize.

Apparently, my body has a problem manufactoring an umbilical cord! These cord issues are supposed to be rare... and I had a weird one, twice.

Scary stuff...:

I'm at the point where I'd love to add another child to the family but I'm really scared about the cord issues. Any advice?

[cbparis5]

A great place for information about umbilical cord issues is The Pregnancy Institute: http://www.preginst.com/

Cindy Paris
Mum to Nathan Elliot Paris ^i^
http://NathanParis.com

and Secretary, International Vasa Previa Foundation
http://vasaprevia.org

[hippiemom]

Thank you for posting the pictures! I have heard of this but have not yet seen it... But I am waiting for two babies a the moment and one mom had a lower-lying placenta earlier in pregnancy.. Great information, thank you!

And I am glad your baby boy is here and healthy. 5!!? WOW!

[Tattoomom]

Originally Posted by Tattoomom

My second child was born vaginally at 37 weeks. I had arrived at labor and delivery with a high fever, dilated and thinning. My doctor decided it was best to deliver early, when the baby's heart rate would not decrease, probably due to my fever.

It was an induced labor, using pitocin AND artificial rupture of membranes. After receiving an epidural, my labor and delivery went fairly quick. After a few hours and a few pushes, I delivered a baby girl!

However, my midwife realized after the birth that the baby had a velamentous inserted cord. It was not detected in uteruo through ultrasound.

Ironically, my first child, born 2 years previous, had a very short umbilical cord, that also was not detected until after the birth. His delivery was very hard and long and ended with forcepts. I personally think his cord was stretched to the max to get him out and the doctor didn't realize.

Apparently, my body has a problem manufactoring an umbilical cord! These cord issues are supposed to be rare... and I had a weird one, twice.

Scary stuff...:

I'm at the point where I'd love to add another child to the family but I'm really scared about the cord issues. Any advice?

I have the pathology report from my placenta/cord. It says Battledore Velamentous Insertion.

Doctorjen... what are the chances of me having another UCA? I've had two pregnancies, both had UCA. Is it risky to have anymore pregnancies? I wonder why I have problems with the cords?

[KimC]

Velamentous Insertion

Our first daughter died from VCI. We had a perfectly normal pregnancy. We went in to be induced was put on Petocin for hours and hours. I began having contractions the next morning and afternoon. When the nurse went to check me, I had a big contraction and my water broke on its own. With that all hell broke loose. Blood everywhere. I was examined by a doctor and felt my daughter kick for the last time before I was rushed to emergency surgery. From the time my water broke to the time Mackenzie was born it was 17 minutes. She lived for 5 1/2 hours before finally passing away. We were told her death was like having your jugular cut. She fought as long as she could. She was flown to a trauma center with a NICU and was kept alive until my husband could be with her. He was holding her when she passed.

We had never heard of this horrible thing until weeks after. I'm glad to read of some good outcomes. The death of our daughter was devastating. With our next pregnancy, we made sure that extra caution was taken in locating and examining the insertion of the umbilical cord.

Kim