Velamentous cord insertion in a singleton pregnancy: an obscure cause of emergency cesarean-a case report

Uterine Sandwich Method: A Case of Posterior Placenta Previa in an In Vitro Fertilization Pregnancy Complicated by Velamentous Cord Insertion

The risk of postpartum hemorrhage (PPH) and placental adhesion anomalies, including placenta previa, may be increased in pregnancies conceived by in vitro fertilization (IVF) and other forms of assisted reproduction technologies. The uterine compression suture, known as the “uterine sandwich method,” may be useful in pregnancies complicated by placenta previa. We report an unusual case of placenta previa complicated by velamentous cord insertion, which was treated by a B-Lynch suture, a Bakri balloon tamponade, and vaginal packing.

Neonatal hemorrhagic shock as a consequence of ruptured velamentous vessels – a report of two cases

Background

The objective of the study was to present the rupture of velamentous vessels as a rare but dangerous complication of pregnancy associated with high neonatal risk. Diagnosis of velamentous insertion of umbilical vessels is important to recognize because of the possibility of their rupture during labor. If the condition remains unrecognized, the most important step during labor is prompt and timely treatment of the multidisciplinary team in order to reduce fetal and neonatal mortality and morbidity.

Case presentation

We present two cases of ruptured velamentous vessels, both with good outcomes: in the first case the baby was delivered vaginally after a spontaneous rupture of the velamentous vessels, and in the second case an emergency cesarean section was performed.

Conclusions

Although bleeding caused by the rupture of velamentous vessels is not frequent, the consequences can be serious. The proper diagnosis of the umbilical cord insertion is mandatory during the mid-trimester anomaly scan, but in most cases the condition remains unrecognized until delivery. In the case of a rupture, a prompt reaction of the medical team is crucial in order to save the baby. Sometimes only an urgent 0 Rh negative blood transfusion can avoid a poor neonatal outcome.