Umbilical Cord Attached To Side Of Placenta
In utero, there isn’t any room for error. Every second counts as an organ develops in your baby’s tiny body — if something goes wrong, it could lead to devastating consequences for both mother and child. The umbilical cord is no different. It must be attached properly to ensure good circulation while also protecting the developing organs inside. But sometimes, things go wrong. A velamentous cord insertion is one such issue where this important process occurs at the side of the placenta rather than its base. This can cause complications that are often fatal to either the mother or the unborn baby.
Velamentous cord insertions occur during the sixth week of pregnancy and usually resolve themselves by the eighth week. However, this can be due to a number of reasons including placental problems, infections and even genetic conditions. Most cases of velamentous cord insertions happen because of placental issues caused by infection with bacteria called Chlamydia trachomatis (chlamydial infection). In fact, up to 90 percent of women who have been diagnosed with chlamydial infection will end up having a velamentous cord insertion.
The problem with these infections is that they don’t show symptoms like other illnesses do. Instead, they lie dormant within the uterus until the woman starts experiencing heavy bleeding between her periods. When this happens, the placenta begins growing near the cervix instead of around the abdomen. Because of this growth pattern, the cord has nowhere to attach itself except on the edge of the placenta. Other times, the infection may result from a congenital defect that causes abnormal tissue to form between the amniotic membrane and the uterine wall. And finally, some women simply don’t know that they’re infected until after delivery.
If you think you might have contracted a chlamydial infection, consult your doctor right away so he or she can test for it. He or she will most likely use a sample of cervical mucus to detect antibodies against C.trachomatis. If a diagnosis is made, treatment should begin immediately. Your physician can prescribe antibiotics to treat the infection.
While chlamydial infections are more common among pregnant women, there are many other types of cord abnormalities that can develop into a velamentous cord insertion. These include:
Anomalies of the Umbilical Cord
Abnormalities of the Amniotic Membrane
Other Abnormalities of the Placenta
Cord Insertion Anomalies
Amniotic membrane anomalies account for about 15 percent of all velamentous cord insertions. These defects occur when the umbilical cord doesn’t make proper contact with the placenta. One cause of this is when the front part of the umbilical cord folds over onto itself, creating what’s known as “funneling.” Another possibility is when the umbilicus does not fully develop, leaving behind a small opening called the sinus tract. These two abnormalities alone account for half of all velamentous cord insertions.
When funneling occurs, the ends of the umbilical cord fold back upon themselves. Although this sounds harmless enough, it can cause severe hemorrhaging and scarring along the edges of the placenta. Since the blood flow through the umbilical cord depends on the integrity of the sinus tract, which carries deoxygenated blood from the heart down toward the placenta, this type of anomaly poses serious health risks to the unborn baby. Funneling is typically treated by surgical intervention.
Another condition that can cause a velamentous cord insertion involves the amniotic membrane. Normally, the amniotic membrane acts as a barrier between the fluid surrounding the baby and the baby’s skin. When this membrane is defective, however, the fluid can enter the baby’s body directly through the skin. In addition, the amniotic membrane can become thickened and scarred due to inflammation or trauma. As a result, the fluid can irritate the baby’s skin and impair bodily functions. Women who experience this kind of injury during vaginal deliveries are especially susceptible.
Sometimes, the amniotic membrane can develop holes. In this case, gas and fluids can pass through the hole directly into the baby’s body. Doctors say that even though this situation is rare, it presents the highest risk factor for babies born with a velamentous cord insertion. Fortunately, surgery can repair this defect.
Other amniotic membrane irregularities can also cause a velamentous cord insertion. For example, a thin membrane covering the outer layer of the placenta can tear off in areas, allowing the placenta to contact the mother’s bloodstream. Also, certain diseases including diabetes mellitus, rheumatoid arthritis and systemic lupus erythematosus can affect the integrity of the inner lining of the uterus. This results in increased permeability of the membrane and allows the baby’s fluid to leak out and possibly damage the baby’s skin. Surgery may still be required to correct these kinds of problems.
Although the majority of velamentous cord insertions are associated with placental pathology, this type of cord malformation can also arise without any sort of placental impairment. For instance, if the umbilical cord was twisted too tightly around the neck of the foetus, it may get stuck at the top of the womb. As time passes, the pressure exerted by the umbilical cord may push the head downward, eventually resulting in a velamentous cord insertion.
This same pathophysiology can also develop if the umbilical cord becomes compressed between the abdominal wall and the pelvic bone. This is commonly seen among obese people since their bodies tend to put excessive weight on the lower extremities.
Of course, we mentioned earlier that many of the complications that occur with a velamentous cord insertion are related to placental dysfunction. Here are just a few examples:
Preterm birth – A study conducted by researchers found that preterm births accounted for 60 percent of all velamentous cord insertions. This is perhaps not surprising considering how much of our society revolves around babies being delivered early.
Fetal distress – During a normal childbirth, the baby is carried out of the mother via the vagina. With a velamentous cord insertion, however, the baby must be pulled out feet first using forceps. In doing so, the infant experiences extreme pain and stress.
Intrauterine death – This is another complication that arises with a velamentous cord insertion. Usually, it’s caused by compression of the umbilicus, forcing the umbilical cord upward and putting tremendous strain on the umbilical vein.
Stillbirth – This is more of a preventative measure than anything else. Velamentous cord insertions are thought to increase the chances of stillbirths.
As you can see, a velamentous cord insertion affects everything from the development of the baby to the safety and wellbeing of the mother. Thankfully, although this is a complicated condition, there are numerous methods available to help mothers manage and overcome this problem. From medication to massage therapy, there are plenty of ways to improve outcomes.
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