Insertio Velamentosa

INSERTIO VELAMENTOSA, membranous attachment of the umbilical cord. In this anomaly, the umbilical cord attaches not to the placenta, but to the membranes at a certain distance from the edge

wherein the umbilical vessels in this case go from the point of attachment of the cord to the membrane and to the edge of the placenta between the amnion and chorion (see figure). This anomaly occurs in 0.4-0.8%; in cases of multiple pregnancy it occurs significantly more frequently - in 5%. Due to the possibility of impaired normal nutrition of the fetus during pregnancy, with this anomaly, spontaneous abortions and premature births may occur (in 58% - Winkel). However, the greatest danger to the fetus arises only at the time of delivery. The umbilical vessels passing through the membranes may be in the lower pole of the ovum and rupture when the membranes break. This complication leads to the death of the fetus from bleeding from the damaged umbilical vessels. In rarer cases, the death of the fetus may occur due to compression of the umbilical vessels passing through the membranes against the walls of the pelvis by the fetal head. The main diagnostic sign of this complication is rupture of the umbilical vessels, accompanied by sudden bleeding and disappearance of fetal heart sounds. Therapy - rapid termination of labor (forceps or - with a movable head -

rotation and extraction).