Velamentous cord insertion with low-lying placenta and fetal growth restriction in a singleton pregnancy: a case report

Velamentous insertion is where the umbilical cord does not insert into the placenta- but rather into the membranes, where the umbilical arteries and vein traverse the membranes along the uterine wall unprotected by Wharton jelly before entering the placental margin which in turn causes various complications. This renders vessels vulnerable to compression and rupture leading to adverse outcomes such as Fetal Growth Restriction, preterm delivery, abnormal fetal heart rate patterns and perinatal morbidity. A 29-year-old primi, 38 weeks 1 day, GDM on OHA, with low lying Placenta with Velamentous cord insertion complicated with FGR with normal Doppler was take up for Elective Caesarean section and a baby of 1.8 kg was delivered. Gross examination showed a cord away from placenta running through the membranes. There is a correlation between cord insertion and higher incidence of FGR and cesarean deliveries. Velamentous insertion of cord is taken as a high -risk pregnancy and enhanced care should be provided. Systematic evaluation of placental cord insertion during routine scans is vital for early recognition and improved perinatal prognosis and to prevent complications like FGR, IUFD, massive hemorrhage.