Velamentous cord insertion and placenta praevia

[serendipity]

Does anyone have any information or stories they can share about velamentous cord insertion and/or vasa praevia (low lying placenta)?

I had my 20 week scan two weeks ago and was told by the sonographer that the umbilical cord was attached to the membrane of the placenta rather than squarely in the placenta - in med jargon, a velamentous cord insertion. The OB on duty and the sonographer both assured me that there was no risk to the baby, but that there may be an impact on the labour in terms of bleeding, yada yada yada...essentially told me not to worry too much. So I didn't.

Two weeks later had a follow-up appointment with the doc at the Mercy Family Birth Centre and asked about the cord insertion and what that meant.

Doc told me - very cavalierly I might add - that I had a low lying placenta ('placenta praevia or 'vasa praevia) that was blocking the entrance to my cervix. He told me they would know more by a 32 week scan, but that if the placenta didn't move I would have to be transferred out of the family birth centre and into the main maternity ward for a c-sec.

** note subject for another post - I thought it was obvious that I was in the birth centre because I have strong beliefs about natural birthing etc, so I was a little irritated that the doc was so casual in his mention of the c-sec **

Anyway, did a bit of online research regarding velamentous cord insertion and vasa praevia and was very disheartened and somewhat alarmed to learn that the combination of these two factors puts the baby at a high risk around the time of the due date.

Does anyone know the likelihood of the placenta moving up higher?
Is it worth having a scan earlier than 32 weeks to see if the placenta has moved?
Does anyone have reliable info/stats on these two conditions?

I plan to contact the birth centre for more information, but am also hoping that someone within this trusted network can point me in the right direction (or at least alleviate my fears).

Thanks in advance!

[Mel1977]

Sorry to hear about your disheartening results, I think it would definitely be worthwhile asking for an ultrasound earlier - even if just for your piece of mind. Your doctor would have suggested a c/sect so flippantly because I believe there is a risk of haemorrhage during birth with this condition, not only for you but also for your baby, and therefore he probably assumed it would not be an issue for you.

Good luck with everything, I hope you can get the answers you are looking for. But if you feel uncomfortable waiting be pushy to the point where they give you regular ultrasounds just to shut you up

[Feathertop]

That all msut have been a big shock for you, particularly the potential for a massive change in your birth plan.

With the low lying placenta, I understand they leave it until 32 weeks as by then most have moved nicely up and out of the way. I think if you had repeated scans between now and then you'd probably get a bit disheartened if it wasn't moving a little each time. I know if it was me I'd leave it until 32 weeks and then see where we are at. My friend whose girl is 3 weeks older than our boy was found to have a low placenta at 20 wks and had the same coversation with the dr re possible c section. Her placenta, like most, moved up and out o the way by 32 weeks and she went on to have a great birth - laboured at home to 9cm, no drugs, natural delivery. Oh, I've found some stats re placenta praevia. Rate is one in every 200 pregnancies, and only 2-5% of women who were found to have a low placenta at 20wks went on to develop placenta praevia bad enough to need c section. Sounds as though you have vasa praevia not placenta praevia, is that right? Or do you have both?

From the eMedicine site (and other medical sites):
Velamentous insertion: 1% of singletons, 15% of twins, common in triplets. Risk of haemorrhage if vessels torn when membranes rupture.
Vasa praevia: where the vessels are in front of the presenting part of the baby (kinda like having the placenta over the cervix, here the large vessels are situated over the cervix and adhered to it), rate of 1 per 2000-3000 deliveries. Vessels not likely to move out of the way but can do so. Monitoring during labour can show some of the indications of distress or vessel rupture. Doesn't say how often the vessels do rupture, but that event has a terribly high mortality rate for the baby (50-75%). Suggests c section is the best way for safe delivery due to these risks. On the positive side, where this is diagnosed early and delivery by c section, baby survival rate is 97% - unfortunately where it isn't discovered until birth, survival rate is only 48%. Oh gosh, that's scary!

I find lots of the website info a bit scary, perhaps you could return to your Dr and go through it all a bit more slowly? Or perhaps see a specialist in VP and VCI? I'm thinking with all this scary info that I'd be asking for a specialist US to be done (I know in my area there's an incredibly skilled OB who only does US and antenatal diagnosis work, she's fantastic) to check where exactly the vessels are, as it seems there is a big difference between having just VCI and having both VCI and VP.

There is a US vasa pravia website for the international VP foundation, perhaps it is worth looking at that if you haven't already?

I hope things turn out well for you, I'm wishing you all the best, please stay in touch and let us know how you get on with further investigations and also with the eventual birth of your lovely baby.

[serendipity]

Many thanks to both you lovely ladies. Must admit that upon first hearing the news I was stressed and distraught - probably due to lack of information than anything else.

Have now spoken with my birth attendant and a couple of midwives, all of whom were fantastic in providing practical advice and comforting info.

Thanks also for the stats, very reassuring. I think I'm now going to wait until the 32 week scan to see if its moved - and think lots of positive thoughts!

[Feathertop]

Good luck serendipity, wishing you and bub well, keep in touch.

[BellyBelly]

For the low lying placenta, did you read the BB article?

Low Lying Placenta & Placenta Praevia

Sorry I can't help with the cord insertion, not come across it before.

[paradise lost]

Re: your cord insertion - make sure that you do not allow anyone to pull on your cord for the 3rd stage. This sounds obvious but it happened to me (i ended up taking the pitocin injection so she'd stop!) and the cord is slightly more likely to snap that a regular one. This needn't be a problem at all, just mention to the midwives when you arrive that you have the irregular cord insertion and want the 3rd stage to be as "hands off" as possible.

Bx

[cbparis]

Hi! Hey, its great that you've been diagnosed with velamentous cord insertion. It wasn't that long ago that this was very seldom diagnosed, especially in Australia. VCI is not automatically vasa previa though. However, you really need to be scanned with transvaginal color doppler ultrasound to rule out vasa previa. Vasa previa is a condition where those velamentous vessels cross the cervix. In this case the baby cannot be born without breaking them and bleeding to death during or even before birth. While the placenta can remodel and "move", the vessels themselves do not have the ability to do this. VCI by itself is not automaticaly a dangerous condition, but vasa previa is! If you do have vessels crossing the cervix you will need to be hospitalized during the last trimester (usually this is done around 30-32 weeks) and be delivered via C-section at about 35-36 weeks. With this management nearly 100% of vp babies survive. Without it, almost 95% of them die. So, you see, this diagnosis is a very good thing. But be sure that they do that transvaginal scan. The transvaginal part is important because at your stage of pregnancy they cannot get a good enough view of the cervix without it to rule out vp. The hospitalization is important if you have vp too, because if those vessels rupture your baby will have to be delivered immediately and given blood transfusions. Babies that rupture at home do not survive. Mine is one that didn't. But I was not blessed with the gift of diagnosis.

I too was planning to have a natural birth - at home even. I didn't even go into labor. I don't advocate hospital births for anyone except those that want them or need them. Vasa previa cases must be delivered by C-section though. These babies just don't survive otherwise. There are a handful of cases that have, but not many!

As disheartening as it is to have this sort of complication, vasa previa is one condition you definitely want to know about. Knowledge is power though and the more you know about vp, the better. I work with the International Vasa Previa Foundation and have seen some 2000 cases come across my desk in the last 5 years. You've been handed a gift. The most precious one you will ever receive. I've included links to more information below. There are lots of stories of vasa previa babies on the IVPF website (below) and also, lots of people who've experienced vasa previa or are currently expecting vp babies in the email group listed below. All the best to you! Feel free to contact me if you want.

Kindest regards,
Cindy Paris, Secretary
International Vasa Previa Foundation
Mum to Nathan Elliot Paris ^i^
http://NathanParis.com
Cindy.Paris@vasaprevia.com

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

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

Vasa_Previa email group:
http://groups.yahoo.com/group/Vasa_Previa

Medical Resources
http://IVPF.org/resources/resources.htm

Slide Show on vasa previa
online - http://IVPF.org/Docs/IVPFslideshow.htm

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

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

Sophie's Walk for Vasa Previa
http://SophiesWalk.org/walk

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

Save babies from an untimely death due to vasa previa by JOINING the IVPF as a participating member! Visit http://IVPF.org/contact/member.htm

[MyLittleMiracle]

Dear Serendipity

My little miracle, Savannah, was born four weeks and two days early on 11 December 2007. I call her my little miracle because she was IVF - not because of the velamentous cord insertion.

I was totally oblivious to the condition until after she was born.

My membranes broke at home, I rang the hospital and they asked if the fluid was clear - I didn't actually check the colour intially - I just knew there was a lot of it! Off we went to hospital and she was induced. After she was born and sent off to NICU as a precaution, because she was early, the midwife told me I had a quite unusual placenta and she was keeping it to show her students. I wasn't going to look at the placenta because I had seen one before but when she told me it was unusual I asked her to show me.

She told me that it was a velamentous placenta and that they don't see them very often. She told me that if my membranes had broken across the vessels that are between the placenta and the cord, especially if it happened at home, it could have been a disaster for the baby, because of massive bleeding.

Obviously all turned out okay for us but there is one thing I would do differently if I knew about it before her birth - I would have checked the colour of the fluid as soon as my membranes broke.

I was also told that it is unlikely to happen with subsequent pregnancies.

Good luck with the forthcoming birth of your bub.

[sonjiji]

Hi Serendipity,

I too have been diagnosed with vasa praevia. It was picked up in my 20 week scan and I had a further scan the other day (now 28 weeks) and it is still present. I am now waiting for the 34 week scan to see if things have improved.

I have found it very difficult to find any information on this condition and what I have found has been quite worrying and far from positive.

If you're interested in an information exchange, I'd love to hear what you have been told.

S

[serendipity]

Hi Sonjiji,

My daughter was born by c-sec over 9 months ago and, hindsight being a beautiful thing, I wouldn't have had it any other way!

In the end, I was diagnosed with three separate conditions: velamentous cord insertion (VCI), vasa praevia (cord over cervix) and placenta praevia (placenta over cervix). My placenta had moved out of the way by my 32 week scan, however the umbilical cord was still VCI and vasa praevia.

I found out near the end of the pregnancy that the VCI would never change and that it was unlikely that the cord would move away from the cervix. However I hadn't been told this at the original diagnosis (my 20 week) so for ages I held out hope that I would be able to have a natural birth.

At the 32 week scan i was told that nothing had changed with regads to the VCI and vasa praevia, but was happy to know that the placenta had moved away from the cervix. After that scan I had an appointment with the birth centre midwife who told me that I would have to be transferred out to the 'main stream' ward; that the risk of the cord rupturing was too great and that I would need monitoring. At this stage I did not have an OB so the midwife set up an appointment and assigned me to a doctor in the hospital. I went to see him 2 weeks later and, after waiting over 2 hours, was told that I would "probably" have to have a c-sec but he would see me in another 2 weeks to make sure.

I have to tell you, I was really uncomfortable after this appointment - I felt that I was given little info on the subject, was being pushed into main stream program, was scorned at by the doctor for originally choosing a natural birth and that I had little choice about the c-sec. Also, and I know this sounds terrible, but I had zero affinity with this doctor and the thought of him doing any examination on me in the future made me shudder. So after this appointment I researched other doctors in the hospital and made an appointment to see one a week later.

I don't know if it was because she was female or simply not that other doctor, but I felt very comfortable with her - she immediately sent me for an internal scan, something that no one had done on me previously. She wanted to know exactly what we were dealing with (i.e. was it actually vasa praevia ro not). Turns out it was. She gave me a lot of verbal info on the subject and told me that the situation would be extremely serious if I was to go into labour. And with that in mind, she wanted to hospitalise me that afternoon and deliver my baby by c-sec two days later!

That was a lof of info to take in in the space of 45 minutes! But she told me that if i was to go into labour, any pressure by the baby on the cord would most likely result in a repture which could be fatal to both mother and baby. Perhaps if i had been with a less understanding doctor or one i was not comfortable with, I would hve freaked out and asked for a second opinion. But I trusted this doctor and therefore was totally ready to put myself under her care.

After that appointment I was immediately taken to the peri-natal ward for additional testing. I was then told to go home, pack my bags and return that afternoon to check into the hospital. Once I had checked in I was visited by a ream of doctors who would all be involved in the c-sec. Each one told me their role in the surgery, managed my expectations and allievated my fears. I felt I had the best care I could possible receive - I'm not sure I have the adequate words to appropriately express how safe I felt under their care.

I had always wanted a natural birth and there I was having the most interventionist birth possible - but I was understood the dangers of the situation I was totally appreciative of modern medicine. Big picture - I wanted a healthy baby. And that's exactly what I have now. Caitlin was born 4 weeks early and was slightly under the preferred weight. She spent one night in 'special care' and was then moved into my room. She is small for her age, but is developing just as rapidly as her peers.

I don't have the experience of child birth that i originally wanted, but I have a beautiful girl and I wouldn't change it for anything!

Not sure I've answered any questions you may have so feel free to ask way

Cheers,

[sonjiji]

Hi Serendipity,

Thanks for your reply and sorry, I just completely read your dates wrong.

It was comforting to read about your experience as mine has, so far, been similar. This is my second baby. I had an emergency caesar with my first and was very much looking forward to a VBAC this time around.

I've been given very little information about the condition, just little bits every time I see the OB at the hospital. My GP has been great but is the first to admit she is no expert. Looking online is just terrifying, there are so many horror stories. It doesn't help that I live in a small village 30 minutes from the nearest qualified hospital.

I'm due for another scan at 34 weeks, which is 5 weeks away so we'll see what happens then.

S

[Juniper]

Hi was wondering if anyone can shed some more info on vasa pevia. I am 32 weeks with my second child and was just told I have vasa previa/ plecenta previa. I have googled it but info sounds scary. My OB seemed to think it was no big deal and that I should have a c-section at 37weeks. I must admit I am and was quite upset since my first labor was natural and went for 3 hours with no complications.
I am suppose to be working till 36weeks and told him so but he found that not to be a problem. My job is very physical and I carry heavy things so is this still alright?
Am I worrying for nothing????

[sonjiji]

Hi Juniper

From what I was able to find out, VP and PP are not much of an issue in Oz because of our routine ultrasounds and quality of healthcare for everyone. I was advised to take things easy from 32 weeks on and had to cancel a trip away as I was advised not to stray too far from the hospital. There is a chance things could go wrong but the mortality rate in Oz is nil for both mother and child.

My GP told me the US and UK are a different story and that is where the online horror stories mostly come from. Ultrasounds are not routine in the US and if you want one you have to pay for it, not like the gap payment we pay but a few hundred $$$. Also, proper ultrasound machines are few and far between so they also have to travel great distances to get to one, in many cases. For this reason the conditions are rarely diagnosed before a woman goes into labour and of course, once she does, the placenta or cord rupture, bleeding starts and so on...

Having said all that, my partner and I sweated bullets until our little one came out safe and sound by planned caesar at 37 weeks. Even my in-laws got a bit worried and came and stayed with us for the last 6 weeks (yeah like that was helpful). There was some excessive bleeding but not enough to require a transfusion and it took them forever to stitch me up, to the point where the anaesthetic was wearing off and it got a little uncomfortable but not painfull.

I was, at first, disappointed not be able to have a natural birth but in the end I just didn't care so long as we were all safe and, to be honest, a planned caesar is a rather civilised method of birthing.

My advice is to take your doctor's advice but do whatever makes you feel safe and comfortable. If you feel your job is too much, ask for a certificate to finish early and if your doc won't give you one, try your OB or find a doc who will. Take care of yourself and use the fact that you know your birthing date as an opportunity to take care of everything before you go in, you know, haircut, pedicure, waxing, massage, whatever makes you feel good.

I hope that was somewhat helpful and that everything goes well for you.

S

[Juniper]

Dear Sonjiji,
Thank you so much for sharing your experience it has put my mind at ease. I will tell work tomorrow and finish up in 2 weeks and that will make me 34 Weeks and just relax. I had never heard of this condition before and my OB warned me not to google it but since I knew nothing about it I couldn't resist.
So glad everything worked out well for your family.

[serendipity]

Hi Juniper,

it sounds like a very solid and sensible plan!

I know the OBs mean well when they advise not to look things up online...but when we're given only a small amount if information, IRS natural to want to know more! Unfortunately, as the previous poster said, so much info online is horror stories from other countries.

I had my daughter safely delivered at 36 weeks by c-sec. I went through the puclic system and the OB I was assigned was completely unhelpful. I insisted on seeing a different doctor, and she advised an internal ultrasound so that we knew exactly what we were dealing with. I was 35.5 weeks - after the ultrasound that confirmed vasa preavia, she sent me home to get my hospital bag and I was back that afternoon to be admitted for 2 days before the c-sec. They used the two data to give me 2 steroid injections that would help strengthen my baby's lungs, because she was coming out a month early.

They also wanted to make sure I took it completely easy JUST IN CASE! They took absolutely no chance that I would start labour just any where.

So two boring nights in hospital and a c-sec later, gorgeous healthy little girl and safe healthy mum :-)

obviously, in a perfect world, you'd be able to labour your way and give birth your way. But the whole experience really made me realise the importance if a trusting relationship with your Ob and not being afraid to ask for more info.

All the best with the last weeks of your pregnancy and your baby's birth!

[Juniper]

Thanks serendipity,
I'm glad it all went so well. Babies are just so precious. I am going to ask my ob more questions when I see him next week since when he told me I asked nothing.
I was silly to be upset about having a c section I realise now...just as long as the baby comes out healthy is all that matters.
It is so nice that people like you and Sonjii share your experiences because when there is not a lot of positive information out there it is quite daunting.
I'm 33 weeks and finishing up work at the end of this week just to make sure it doesn't come early like my first did.
I will rest and relax and keep you posted how thing go.