Velamentous cord insertion as a risk factor for obstetric outcome: a retrospective case-control study.
OBJECTIVE
Velamentous umbilical cord insertion (VCI) is associated with adverse pregnancy outcomes. Literature lacks data on Doppler. We aimed to evaluate obstetric outcomes and results of uterine and umbilical artery Doppler flowmetry associated with VCI.


METHODS
In a retrospective case-control study, 108 singleton pregnancies with VCI were age- and body mass index-matched to 108 singleton pregnancies without VCI. The main outcome parameters were obstetric outcome, pregnancy-related complications, uterine artery flowmetry at the second-trimester screening, and umbilical artery flowmetry before delivery. Statistical analysis was accomplished using Pearson's Chi-square test or Fisher's exact test, and the Mann-Whitney U test, where appropriate.


RESULTS
Pregnancies with VCI revealed a significantly higher PI in the umbilical artery during the last measurement before delivery (1.00 ± 0.25 vs. 0.90 ± 0.10; p = 0.001). Gestational age at this measurement did not differ between the groups. Fetal malformations and intrauterine fetal death were more common in pregnancies with VCI (12.7 vs. 0 %; p < 0.001, and 6.5 vs. 0 %; p = 0.014, respectively). Patients with VCI delivered significantly earlier (36.2 ± 4.5 vs. 38.4 ± 2.6; p < 0.001).


CONCLUSIONS
Higher rates of (early) preterm delivery were found in pregnancies with VCI. Fetuses with VCI also suffered from malformations and IUFD more frequently. The last pulsatility index value in the umbilical artery, before delivery, was significantly higher in pregnancies with VCI, which is of uncertain clinical value.
Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria.
Gülen
G
Yerlikaya
Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria.
Sophie
S
Pils
Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria.
Stephanie
S
Springer
Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria.
Kinga
K
Chalubinski
Department of Obstetric and Gynecology, Medical University Vienna, Waehringer Guertel 18, 1090, Vienna, Austria. johannes.ott@meduniwien.ac.at.
Johannes
J
Ott
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D017078:Laser-Doppler Flowmetry; D010920:Placenta / Q000000981:diagnostic imaging / Q000473:pathology; D010922:Placenta Diseases; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011256:Pregnancy Outcome; D047928:Premature Birth; D012189:Retrospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014469:Umbilical Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014470:Umbilical Cord / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000196:embryology
Doppler; Pulsatility index; Umbilical artery; Vasa previa; Velamentous cord insertion