Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies

Objectives-To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa. Methods-This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction. Results-Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P=.039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P=.045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P=.012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P=.14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P=.21), and fetal or neonatal death (3.8% versus 0%; P=.11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P=.013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P=.036). Conclusions-Isolated confirmed velamentous cord insertion is associated with adverse perinatal outcomes in singleton and twin gestations.