Volume 11, Issue 1 (2026)
SJMR 2026, 11(1): 50-55 |
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Giti S, Jalali Zand F, Nateghi M R. Intrauterine Fetal Demise Associated with Velamentous Cord Insertion: A Case Report and Review of the Importance of Prenatal Diagnosis. SJMR 2026; 11 (1) : 8
URL: http://saremjrm.com/article-1-393-en.html
URL: http://saremjrm.com/article-1-393-en.html
1- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
Abstract: (11 Views)
Introduction: Velamentous cord insertion is an important abnormality of the umbilical cord insertion into the placenta, in which the umbilical vessels, before reaching the placenta, traverse between the fetal membranes without the protection of Wharton’s jelly. This condition may be associated with multiple complications, including intrauterine growth restriction (IUGR), preterm delivery, fetomaternal hemorrhage, placental abruption, low Apgar score, hypoxic-ischemic brain injury, and intrauterine fetal demise. Despite the clinical importance of this abnormality, its diagnosis in many cases is delayed until delivery or pathological examination of the placenta.
Case Presentation: A 36-year-old woman, G2P1L1, with a history of previous cesarean section due to fetal macrosomia, gestational diabetes, polycystic ovary syndrome, controlled hypothyroidism, and obesity, was followed from 26 weeks of gestation. Throughout pregnancy, serial ultrasound assessments of fetal growth, amniotic fluid volume evaluation, Doppler studies, and fetal well-being tests including biophysical profile and non-stress test (NST) were performed regularly and reported as normal. At 34 weeks of gestation, twice-weekly fetal surveillance was initiated. Despite normal findings in the latest evaluations, the patient experienced decreased fetal movements three days later but presented to the medical center with a two-day delay. Evaluations revealed intrauterine fetal demise. During cesarean section, completely bloody amniotic fluid and evidence of placental hematoma were observed. Pathological examination of the placenta confirmed velamentous cord insertion, a finding that had not been detected in prenatal ultrasounds.
Conclusion: This case report demonstrates that velamentous cord insertion can be associated with catastrophic outcomes such as intrauterine fetal demise, even in the presence of regular prenatal care and apparently normal fetal assessments. Careful evaluation of the umbilical cord insertion site during the second-trimester anomaly scan and documentation of it in the ultrasound report can play an important role in identifying high-risk cases and planning closer maternal-fetal surveillance. Increasing awareness among obstetricians, perinatologists, and sonographers regarding this abnormality may contribute to reducing severe maternal and fetal complications.
Case Presentation: A 36-year-old woman, G2P1L1, with a history of previous cesarean section due to fetal macrosomia, gestational diabetes, polycystic ovary syndrome, controlled hypothyroidism, and obesity, was followed from 26 weeks of gestation. Throughout pregnancy, serial ultrasound assessments of fetal growth, amniotic fluid volume evaluation, Doppler studies, and fetal well-being tests including biophysical profile and non-stress test (NST) were performed regularly and reported as normal. At 34 weeks of gestation, twice-weekly fetal surveillance was initiated. Despite normal findings in the latest evaluations, the patient experienced decreased fetal movements three days later but presented to the medical center with a two-day delay. Evaluations revealed intrauterine fetal demise. During cesarean section, completely bloody amniotic fluid and evidence of placental hematoma were observed. Pathological examination of the placenta confirmed velamentous cord insertion, a finding that had not been detected in prenatal ultrasounds.
Conclusion: This case report demonstrates that velamentous cord insertion can be associated with catastrophic outcomes such as intrauterine fetal demise, even in the presence of regular prenatal care and apparently normal fetal assessments. Careful evaluation of the umbilical cord insertion site during the second-trimester anomaly scan and documentation of it in the ultrasound report can play an important role in identifying high-risk cases and planning closer maternal-fetal surveillance. Increasing awareness among obstetricians, perinatologists, and sonographers regarding this abnormality may contribute to reducing severe maternal and fetal complications.
Article number: 8
Keywords: Velamentous Cord Insertion, Intrauterine Fetal Demise, Stillbirth, Umbilical Cord Abnormalities, Placental Pathology, Placental Abruption, Case Report.
Article Type: Case Report |
Subject:
Pregnancy Care
Received: 2026/06/1 | Accepted: 2026/06/19 | Published: 2026/06/23
Received: 2026/06/1 | Accepted: 2026/06/19 | Published: 2026/06/23
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