Velamentous insertion of the umbilical cord - Mothering Forums

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#1 of 95 Old 01-31-2005, 05:01 PM - Thread Starter
 
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My last baby was born at 37 weeks due to his placenta being a VCI (velementous cord insertion). I was blessed that he was healthy and that I recognized that things were going oddly. Not bad, not good, just different. I had a wonderful OB who recognized the distress that he was in. This was the first and only time I had a VCI baby and had never heard of it before. I have done a little research and found out that it is associated with Vasia Previa in the sense that all Vasia Previa pregnancies have VCI, but not all VCI pregnancies are Vasia Previa. This is also unusual with singleton p.g.s and more often associated with multiples. Just wondering if anyone else has heard of this or experienced it?
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#2 of 95 Old 01-31-2005, 06:45 PM
 
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I am an NICU nurse, you bet I've heard of this. Babies with Vaso-previa are pretty sick...many of them die of something called DIC. I am thankful that you have a happy ending. Your story is a great arguement for OB care.

Erin
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#3 of 95 Old 01-31-2005, 09:03 PM
 
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What exactly was going oddly?
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#4 of 95 Old 02-12-2005, 06:10 PM
 
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Also curious. I ama student midwife and have been at a homebirth with a velamentous cord inserttion and since there was no intervention everything was fine. Water broke with the birth of the head, baby born quickly after. Placenta delivered with no traction, an excellent argument for midwifery care!
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#5 of 95 Old 02-12-2005, 07:38 PM
 
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I have had several clients with a velamentous insertion of the cord, and as weesej said, it wasn't a problem. It IS a problem when the membranes are artificially ruptured (as many OBs do) because if there is a vasa previa (a vessel running through the membranes overlying the cervix) and the hook used to rupture the membranes snags the vessel, then the baby can be in life-threatening distress. Most ruptured vasa previa are iatrogenic (caused by medical personnel).

I do disagree that all vasa previa have a VCI though. Sometimes an errant vessel from the margin of the placenta is is what is overlying the cervix, and the cord insertion can be totally normal. Sometimes the vasa previa is connected to a succenturiate lobe, and again, not connected to the cord insertion at all.

Erin Daughterty, can you explain the physiology behind your comment that many babies with a vasa previa have DIC?

I think that any good caregiver, regardless of whether they are an obstetrician or not, can often detect fetal distress and compromise.

Carolynn
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#6 of 95 Old 02-12-2005, 10:33 PM
 
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I've had 2 velamentous insertions of the cord in my practice. Both were nice, healthy babies, born vaginally with no fetal distress. Both times I was so relieved after that I hadn't ruptured the membranes artificially - I just kept thinking about how awful it would have been to hook one of those nice plump vessels when the mom was 5 cms and then try to get a cesarean going fast enough to get the baby out before she bled to death! I rarely rupture membranes anyway, but after those 2, I really avoid it. The first birth, mom's membranes must have ruptured while she was on the toilet (we never figured out when as there was no obvious gush of water) and the second mom's water broke just before crowning during pushing.
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#7 of 95 Old 02-18-2005, 12:17 PM
 
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Hi! I had velamentous cord insertion during my 4th pregnancy, in 1996. Unfortunately, I also had vasa previa. Mine ruptured at term and the baby died a couple of days after birth due to the injuries he sustained. Not much was known about vci or vasa previa back then. I found only 6 medical journal articles on the condition, had to go to 2 different medical school libraries to retrieve them all, and they were all success cases only because they were prenatally diagnosed by accident while following up some other condition. Since then I have helped found the International Vasa Previa Foundation. I've seen many hundreds of these cases in the last 4 years, participated in organizing a major research project on it, and can eliminate some of the confusion here.

Velamentous cord insertion by itself is not all that uncommon. It happens once or twice in every 100 pregnancies. Usually without any problems (about 70% of the time). But it can be very dangerous to the infant and can be prenatally diagnosed. If the vessels cross the cervix (vasa previa) they will with almost absolute certainty rupture at or near term or delivery, with or without the doctor's help (by breaking the waters). Mine broke spontaneously at home as I was going into labor, which is very common for cases of undiagnosed vasa previa. I never had a contraction. Even if the vessel(s) do not cross the cervix (vasa previa), they can still break and sometimes do, but this is pretty rare. They can also be compressed by the baby, effectively accomplishing the same thing. Here at the International Vasa Previa Foundation (IVPF) we are working to ensure that a scan of the placental end of the cord connection becomes becomes routine practice during all obstetrical ultrasounds. The cord connection can be visualized more than 99% of the time, even with only black and white ultrasound (though color Doppler is preferred) and it only takes 20 - 60 seconds to do so.

I have to disagree that not breaking the water in cases of vasa previa will avoid a rupture. This is simply not true. If vessels are crossing the cervix, the baby cannot be born vaginally (in almost every case) without these vessels rupturing. As this is fetal blood, a rupture will immediately compromise the infant. It was highly unusual that I made to the hospital while my baby was still alive. His heart stopped after arrival and they were able to rescussitate him after an emergency C-section, but it really was too late. Too much damage had been done. The infant mortality rate for undiagnosed vasa previa is 50-90%. I sure wish doctors would check first before breaking the water. Most of the cases of vp that I've heard of that were diagnosed in labor were made by astute midwives rather than OBs.

There are 2 known types of vasa previa: velamentous cord insertion and bi-lobed, succenturiate lobed placenta. Its important to note that most cases of vci or succenturate lobed placenta are not vasa previa though. But if you do have vessels crossing the cervix, you have a disaster waiting to happen. Its like a time bomb waiting to go off at birth. VP happens about once in every 2500 pregnancies.

Since Nathan died there has been a lot more medical papers published on these conditions (about 100 that I know of). IVPF recommendations are based on current research that could only have been accomplished with the help of our organization. The condition is rare enough that doctors seldom if ever see a case. Most notably the recommendations are to check the placental cord connection during routine obstetrical ultrasounds, and follow up with transvaginal color Doppler ultrasound (the test of choice) for any pregnancies with risk factors for vasa previa. Risk factors include vci; bi-lobed/succenturiate lobed placenta; low-lying placenta (even if it corrects itself!); maternal history of uterine surgery or D&C; multiple gestation (twins, triplets, etc); and assisted conception (i.e. in-vitro fertilization). If vasa previa is found, the IVPF recommends pelvic rest (including no vaginal exams other than the transvaginal ultrasound), hospitalization in the 3rd trimester, and C-section delivery by 35 weeks. They also recommend immediate blood transfusions for the infant if a rupture does occur. A vp rupture is painless for the mother, unlike other forms of bleeding in pregnancy. My son lost more than half his blood in only a moment.

LOL! I think I've probably over done it. As you can tell, I am passionate about this subject. Babies don't need to die from vasa previa, though in the past almost all of them did. Prenatally diagnosed cases that are properly managed have a near 100% infant survival rate. I've never seen a prenatally diagnosed baby die because of vasa previa. Information is soooo important. Unfortunately, many women have to be their own advocate when it comes to a vp diagnosis. The information hasn't caught up with all the doctors yet. The good news is that more and more vp babies are being prenatally diagnosed all the time and its become very easy to research this condition on the internet. So sorry for the long post! Thanks for listening. I hope this helps.

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

Sign up to receive the free IVPF newsletter:
http://groups.yahoo.com/group/IVPF

To join the Vasa_Previa email discussion group, visit:
http://groups.yahoo.com/group/Vasa_Previa

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

IVPF Slide Show about vasa previa
online - http://www.vasaprevia.org/Docs/IVPFslideshow.htm

IVPF Brochure
http://www.vasaprevia.org/Docs/IVPFbrochure.PDF

Frequently asked questions about vasa previa:
http://www.vasaprevia.org/faqs/faqs.htm

Help us research vasa previa by filling in the IVPF research questionnaire:
http://www.vasaprevia.org/education/questions.htm

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...
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#8 of 95 Old 02-20-2005, 01:17 PM
 
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Quote:
Originally Posted by erindaugherty
Your story is a great arguement for OB care.Erin
Why?

This will happen no matter where the birth takes place and no matter who is managing the labor and delivery.

The baby is healthy because the mom did a good job of caring for her before the birth, not because of who the healthcare provider is.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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#9 of 95 Old 02-20-2005, 02:20 PM
 
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erindaugherty, im also curious about the relationship between disseminated intravascular coagulation and VCI. ive never heard that before. . . .

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#10 of 95 Old 02-25-2005, 08:38 PM
 
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#11 of 95 Old 03-27-2005, 10:40 PM
 
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I am a NICU nurse too and I want to hear the connection between DIC and VP too. I've seen the connection between placenta previa and DIC in mom but haven't seen the VP/DIC one. But maybe I haven't seen enough VP cases.

Scary though, now I wish I had asked for the ultrasound guy to look at that. Darn it! Now I have one more thing to worry myself with.
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#12 of 95 Old 03-28-2005, 11:56 AM
 
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Hi,

I had a velamentous insertion of the cord with my first pregnancy, but not a vasa previa. I had sensed something was wrong with the cord, and actually had 5 ultrasounds including vaginal ones to look to see if anything was crossing the cervix (mostly because I also had a borderline low-lying placenta as well). The cord and insertion was looked at on ultrasound and no abnormality was detected. Even after birth, they were not sure it was a velamentous insertion until it was dissected by pathology. From what I have read, velamentous insertion can be picked up by ultrasound some of the time, but not always even with the highest level ultrasound. By the way, I had a 100% normal, healthy pregnancy and even did non-stress tests (I was overdue) which were all completely normal. Even if the velamentous insertion had been detected, no intervention would have been taken.

In my case, my water broke spontaneously at home. At this time, some of the vessels ruptured where the placenta inserted the membranes and my baby bled out. Fortunately we were near the hospital and had a great neonatology team and the baby survived. She does have moderately severe cerebral palsy (can't sit at 20mo), seizures, etc., but is cognitively pretty good. She had extremely profound and diffuse brain injury so nobody quite understands how she is doing so well.

Where I gave birth (largest maternity hospital in IL by volume of births), the high-risk OB who had been there 30 years had only seen this 5 times. Almost all of the babies die. My daughter is one of only a few survivors that we are aware of.
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#13 of 95 Old 04-10-2005, 01:57 PM
 
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My daughter had her first baby four years ago. The baby only lived for four days due to lack of brain activity. She was the victim of a velamentous insertion. I should say, the whole family was victimized by this not-so-rare occurrence. My daughter had a hysteroscopy two years before becoming pregnant due to a uterine septum discovered on a routine ultrasound. From what I have read, that could have been the cause of the VI, since no other possible causes were present. She went into labor right after her water broke, but was in the hospital within two hours of that. She was hooked up to a fetal monitor, but lost baby's heartbeat, so husband called the nurse who discovered vaginal bleeding. Still no heartbeat, so OB was paged and rushed her into operating room for an emergency c-section. That took about 25 miutes before delivery. Baby was stillborn but they managed to revive her, why I do not know! She had been without oxygen long enough to consider her deceased. Anyway, forensic examination of placenta and cord found a velamentous insertion and the blood vessels had ruptured at the time of the baby's heartbeat being lost. Baby lived for four days on respirator, which mom and dad decided to disconnect since EEG was flat. She was a beautiful, full-term perfect baby, who could have been saved if OB had ordered a couple of high-level color doppler ultrasounds. I believe this should have been done considering the uterine surgery my daughter had previously. Since that time, she has had two more children, both fine, no VI, but she had several doppler ultrasounds during pregnancies. My other daughter will deliver a baby this week by c-section, also due to a finding just 10 days ago, of an extra lobe on the placenta, with a blood vessel running through it, ALSO DISCOVERED ONLY ON A HIGH LEVEL COLOR DOPPLER ULTRASOUND!! When do you guys think the insurance companies will start paying for this target ultrasounds as a routine practice?? It is a sin they do not!
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#14 of 95 Old 05-05-2005, 03:51 AM
 
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Wow--thank you all so much for sharing these stories and information! I never would have understood this condition otherwise--and how important to know that harm to the baby is preventable.

I am 26 weeks, first pregnancy, have already had a level II ultrasound. I am going to find out if they will have another chance to look at the cord where it meets the placenta. I will ask the doc at my next appointment.

I will also share this with others since it is so important to prevent.

Again, thanks and bless you.

--Adrienne
expecting boy: 8/10-ish
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#15 of 95 Old 05-05-2005, 04:07 AM
 
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i never even *knew* about this stuff.

how scary. thank you for all of the information everyone.
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#16 of 95 Old 03-06-2006, 02:59 PM
 
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Hello. I am 35 yrs old and 18 1/2 weeks pregnant. This is my 2nd pregnancy (miscarried last time). I went for 2nd level 2 ultrasound last week and everything looked good until last 5 mins when they found cord was not inserted in "ideal" place in placenta. Tech said it was probably fine-she showed pics to doc (perinatologist) who said it was not serious enough to come in and talk to us. We however requested to ask him a few questions. Unfortunately he was one of the biggest jerks I have ever met. He said it would probably (90-95%) be fine and that I would have to come back in 6-8 weeks for another US to make sure baby was growing correctly. When I asked what it would look like if baby was not growing correctly, he said "I would rather not have that 20 min conversation right now." He did tell me it is very positive that insertion is up high in my uterus, not low near cervix and said it is velamentous cord insertion. I did some research over weekend b/c my OB is on vacation and I can't get in to get her perspective until late this week. All the studies I found include data that is quite old. What I am wondering is, can placement of insertion of cord change? Now it is up high so doesn't seem like it is vasa previa, but can vasa previa develop over course of pregnancy? Second, when things go wrong with VCI (VCI only, not vasa previa) , what is most likely to happen? I read about 7 different anomalies are associated with VCI and don't know which is most common and what percentages of occurrence are? Any other suggestions anyone has to help me both learn more about this and cope with the anxiety it produces would be much appreciated. Thanks so much. Jennifer
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#17 of 95 Old 03-06-2006, 09:40 PM
 
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I want to share a positive VCI story, since I can tell some of those who have posted are growing with worry. My water broke just as labor began at 39 weeks and I had an absolutely ecstatic, normal birth at home. I had an (undiagnosed) VCI and a succincurate lobe. My cord evulsed (snapped off) as the placenta was being delivered but in the end my placenta came without any trouble and only slightly excess bleeding (not enough to categorize as a hemorrhage.)

I do agree that babies with proven vasa previa should be born by c-section, but worry that in this culture, if we routinely look at cord insertion as part of the ultrasound and there is even a question of a VCI or some other abnormality, we will have even MORE unnecessary c-sections. These are associated with life threatening (as well as many less severe) complications for both mothers and babies, including very significant risks for subsequent babies conceived after the cesarean. Ironically, these risks may include vasa previa itself! They certainly include placenta accreta (lifethreatening to mom), placenta previa, and intrauterine growth restriction for the baby. Just some food for thought. Vasa previa is a devastating complication, but thankfully quite rare. There is an important role for prenatal diagnosis, but information that is poorly understood (by docs, perinatologists, midwives, etc.) can be more dangerous than no information at all.

FYI, I think the DIC link is that any person (baby or adult) that loses a large amount of blood can be at risk of DIC. This can happen at the extreme end of postpartum hemorrhage also, but is thankfully incredibly rare because of all of the effective interventions we have to control hemorrhages when they happen.
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#18 of 95 Old 11-07-2006, 04:25 AM
 
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I had a positive outcome as well.

I had severe bleeding at about 13 weeks, felt like my water had broken. I went to the emergency room and they said my cervix was dialating and I would miscarry. That never happend. The bleeding went on for about a month, and everytime they did an ultrasound or fetal heart check it was fine. At my 20 week ultrasound they found that my daughter had a two vessel cord. No biggie since they didnt see any other abnormalities.

Fast forward to the end of my pregnancy. I was overdue and was induced with pitocin and they broke my water. My baby girl came out, perfectly healthy, apgars of 8 and then 9. She was 7 lbs 2.5 oz.

When the placenta came out the midwife announced that it had a velamentous insertion. My daughters pediatrician came to the hospital right away, and they did a few ultrasounds of her organs and such. We went home from the hospital the next day, and she is a happy healthy 11 month old today. I was on edge my whole pregnancy, because of the bleeding and then the vessel problem... I am glad I didnt know about the insertion issue. My daughter and I are living proof that babies with this issue can be happy and healthy.
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#19 of 95 Old 11-07-2006, 06:13 PM
 
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I just gave birth a week ago, unassisted, and I had a VCI. Unknown before the birth of course, because I did my own prenatal care. The birth went without a hitch, so I doubt I had vasa previa. You can read my birth story here (http://www.mothering.com/discussions...d.php?t=552790) and see pictures of the VCI on my blog (http://rixarixa.blogspot.com).

I had no abnormal bleeding, no signs of anything being out of the ordinary. Just a straightforward labor.
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#20 of 95 Old 02-01-2007, 01:19 AM
 
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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?
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#21 of 95 Old 02-01-2007, 01:51 AM
 
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A great place for information on umbilical cord issues is The Pregnancy Institute: http://www.preginst.com/

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

Secretary, International Vasa Previa Foundation
http://IVPF.org
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#22 of 95 Old 02-01-2007, 01:56 AM
 
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Here is the story of a dear on-line friend's baby. It's a hard story to read.
http://www.karuna.agrawalkids.com/story.html

7yo: "Mom,I know which man is on a quarter and which on is on a nickel. They both have ponytails, but one man has a collar and the other man is naked. The naked man was our first president."
 
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#23 of 95 Old 06-14-2007, 08:47 PM
 
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This thread is old, but it seems as if people are still looking at it for information sometimes, so I thought I'd add my story. Here is the link to my (home)birth story. I also had a VCI, but we weren't at all aware of it until after the baby was born...but it explained a lot.

http://www.mothering.com/discussions...ght=noah+james
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#24 of 95 Old 07-16-2007, 02:31 AM
 
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I had a succenturiate placental lobe at my UC. No Velamentous insertion though. I was warned of the abnormality in dreams, and went to have an ultrasound. I thought there was a problem with the baby though. They didn't find anything. Even after I went to the hospital after hemmoraging, they gave me pit and sent me home with the lobe still inside. Passed it the next day, it was fist sized with a large vein coming off of it. Three weeks later I came near death from a uterine infection too. Had a d & c and some excellent abx's.
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#25 of 95 Old 07-16-2007, 02:48 AM
 
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My daughter was born at home and the fact that there was a velamentous insertion of the cord was an incidental finding when they examined the placenta. Healthy pregnancy, uncomplicated labor. She also was born with a minor congenital heart defect, which is correlated with VCI (but there's no real theory as to which way causation would run, if there's causation at all between the two.) She's a big, healthy toddler now.

Vasa previa is scary, but not all VCIs result in vasa previa, by a long shot. The one thing I have taken away from all this is to NOT allow AROM in future pregnancies. I had SROM at home in a low-intervention birth and that's definitely a good thing!
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#26 of 95 Old 07-16-2007, 10:23 AM
 
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ya know, I think thisis what I had during my last birth (VIC)...my sons cord ran along the outside not truly *into* the placenta.

My M/W had commented that had I had AROM he might have bled out. ( my membranes broke, btw when it head was almost completely out...)

I am so thankful that I have a hands off m/w because I was scheduled to deliver at an OB who waned to force induction on me at 40 weeks ( my son came on his own at 40 weeks 5 days...)

I had had a total placenta previa with him, DX at the 18 week U/s and was gone by 24 weeks...but was still low lying.

My ds is fine now,vibrant healthy, getting intomy cabinets as we speak *LOL*...my m/w said she knew why he had to come quick, and he did! one hour and 58 minutes from first contraction to birth.


Oh and I will add that I had massive bleeding right around the time of conception, or rather implantation, so much so that I had no idea I was even pg until I was almost 4 months along...

I have never bled like that with any of my other kids, ever, and I had that feeling the entire pg (once i found out) that something was wrong...too.

Does anyone know WHY this happens in some pg's? And if you have it one pg can it happen another time too?

just curious. Thanks for bumping this thread
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#27 of 95 Old 07-20-2007, 04:38 AM
 
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I just wanted to explain to those who asked that anytime a person loses a huge amount of blood they are at risk for DIC. You lose clotting factors and the clotting cascade goes awry. It isn't just neonates, its moms or people who lose lots of blood in a trauma.
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#28 of 95 Old 07-20-2007, 11:33 AM
 
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Originally Posted by mamabearing View Post
I just wanted to explain to those who asked that anytime a person loses a huge amount of blood they are at risk for DIC. You lose clotting factors and the clotting cascade goes awry. It isn't just neonates, its moms or people who lose lots of blood in a trauma.
I was just going to reply with a similar answer- DIC from venous collapse triggers some clotting in the circ system - that also triggers the anti-clotting actions that every healthy clot has- but instead of helping anything what it does is end up circulating anti-clot factors
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#29 of 95 Old 07-20-2007, 02:28 PM
 
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I remember when I was in midwifery school and read about DIC...and after researching every other complication that could happen to someone in pregnancy or labor was...ok...DIC wins the prize as the worst possible sounding thing that could EVER happen to anyone.
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#30 of 95 Old 11-14-2007, 03:03 AM
 
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I had a velementous insertion with my son seven months ago. I had a homebirth which was beautiful and baby was never in distress. Shortly after the birth the midwife told me that the placenta was not coming out and that my cervix had closed so they were going to try and gently guide it out. At that point one of the vessels came detatched and I started bleeding quite heavily. I was transferred to the hospital for a manual removal of my placenta. And by manual I mean the resident's hand was right inside my uterus. Luckily the OB was able to talk the resident into removing it by hand, as she wanted to take me to the OR. I don't think these two things (VCI and retained placenta) were linked, but the combined effect was pretty messy. That being said, the babe was not directly affected (except that he missed out on our quiet night at home and had to experience his first ambulance ride at one hour old).

Diane, SAHM to DD (June 05) and DS (April 07).
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