Velamentous cord insertion - Gross and histological examination

Velamentous cord insertion is an abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta. The present case study is an incidental finding during a cesarean section. A 30-year-old woman with 37 weeks of pregnancy, gravid 1, presented with bleeding per vagina. Previous ultrasonography reports confirmed the presence of a low-lying placenta. However, the site of cord insertion was not mentioned in her reports. On cesarean section, a healthy male baby was delivered. The placenta had velamentous cord insertion. Approximately 12 cm of vessels traversed the membranes. In the present case study, the umbilical cord was thoroughly examined, both grossly and histologically. For better understanding, the umbilical cord was also compared with a normal umbilical cord. Morphologically, the length and diameter of the cord were in normal range and blood vessels were patent. Histologically, the slides showed the absence of Wharton’s jelly on the cord. Velamentous cord insertion can lead to many unwanted complications like preterm birth, post-partum hemorrhage, and even fetal death. Abdominal ultrasound can be used to visualize the insertion of the cord; however, it often goes unnoticed, as the insertion site is usually obscured by the fetus. Moreover, maternal obesity and posterior placenta make the diagnosis even more difficult. This case study highlights the necessity to pre-diagnose velamentous cord insertion. It can be done with the help of trans-vaginal ultrasound and color Doppler imaging of the cord vessels.