Velamentous cord insertion: results from a rapid review of incidence, risk factors, adverse outcomes and screening
Open accessAbstract
Background: Velamentous cord insertion (VCI) is an umbilical cord attachment to the membranes surrounding the placenta instead of the central mass. VCI is strongly associated with vasa praevia (VP), where umbilical vessels lie in close proximity to the internal cervical os. VP leaves the vessels vulnerable to rupture, which can lead to fatal fetal exsanguination. Screening for VP using second-trimester transabdominal sonography (TAS) to detect VCI has been proposed. We conducted a rapid review investigating the quality, quantity and direction of evidence available on the epidemiology, screening test accuracy and post-screening management pathways for VCI. Methods: MEDLINE, Embase and the Cochrane Library were searched on 5 July 2016 and again on 11 October 2019, using general search terms for VP and VCI. Only peer-reviewed articles reporting on the epidemiology of VCI, the accuracy of the screening test and/or downstream management pathways for VCI pregnancies were included. Quality and risk of bias of each included study were assessed using pre-specified tools. Results: Forty-one relevant publications were identified; all but one were based on non-UK pregnancy cohorts, and most included relatively few VCI cases. The estimated incidence of VCI was 0.4–11% in singleton pregnancies, with higher incidence in twin pregnancies (1.6–40%). VCI incidence was also increased among pregnancies with one or more other risk factors, including in vitro fertilisation pregnancies or nulliparity. VCI incidence among women without any known risk factors was unclear. VCI was associated with adverse perinatal outcomes, most notably pre-term birth and emergency caesarean section in singleton pregnancies, and perinatal mortality in twins; however, associations varied across studies and the increased risk was typically low or moderate compared with pregnancies without VCI. In studies on limited numbers of cases, screening for VCI using TAS had good overall accuracy, driven by high specificity. No studies on post-screening management of VCI were identified. Conclusions: Literature on VCI epidemiology and outcomes is limited and low-quality. The accuracy of second-trimester TAS and the benefits and harms of screening cannot be determined without prospective studies in large cohorts. Modelling studies may indicate the feasibility and value of studying the epidemiology of VCI and the potential impact of detecting VCI as part of a population screening programme for VP.
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There is ongoing debate regarding whether routine screening for velamentous cord insertion and/or vasa previa should be performed at the mid-trimester scan; the evidence is of limited quality and fails to take into account the consequences of over-diagnosing such anomalies.
“There is, however, ongoing debate regarding whether routine screening for velamentous cord insertion and/or vasa previa should be performed at the mid-trimester scan; the evidence is of limited quality and fails to take into account the consequences of over-diagnosing such anomalies 47,88 .”
From <scp>ISUOG</scp> Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [47]
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Association of placental pathology and gross morphology with autism spectrum disorders
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Magnetic resonance imaging diagnosis of abnormal placental cord insertions
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Velamentous cord insertion ruptured during labour leading to acute fetal blood loss
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Spontaneous Umbilical Cord Vascular Rupture during Labor: A Retrospective Analysis of 12 Cases
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Ultrasound Assessment Before Complex or Difficult Cesarean Section
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Cord insertion anomalies and adverse pregnancy outcomes: more than an incidental finding
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- Authors
- Buchanan-Hughes, A., Bobrowska, A., Visintin, C., Attilakos, G., & Marshall, J.
- Affiliations
- Costello Medical Consulting (United Kingdom) (GB)
- University College London Hospitals NHS Foundation Trust (GB)
- Public Health England (GB)
- Corresponding author
- Marshall, John
- Venue
- Systematic Reviews
- Published
- 2020-06-23
- Volume
- 9
- Issue
- 1
- Pages
- 147-147
- ISSN
- 2046-4053 (ISSN-L)
- PMC
- PMC7313176
- OpenAlex
- W3038013202
- Cited by
- 40
- References
- 74
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 5 · 2021: 7
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Systematic Reviews (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Public Health England
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
- Keywords
- velamentous cord insertion, vasa previa, umbilical cord insertion, prenatal screening, incidence, risk factors, preterm birth, emergency cesarean section, perinatal mortality, twin pregnancy, in vitro fertilization, nulliparity
- MeSH terms
- Cesarean Section, Female, Humans, Pregnancy, Prospective Studies, Risk Factors, Incidence, Vasa Previa
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