Clinical implications of velamentous cord insertion in triplet gestations


      Objective: The purpose of this study was to determine the incidence of velamentous cord insertion and to evaluate the association between velamentous cord insertion and small-for-gestational age infants in triplet gestations. Study design: We reviewed our computerized database to identify all cases of velamentous cord insertion in triplet gestations who were delivered at our institution from January 1995 through December 1999. Triplet gestations without velamentous cord insertion who were delivered during this period were used as control subjects. Birth weights and pregnancy outcomes were obtained from medical records. Data were analyzed with descriptive statistics, analysis of variance, and χ2 with Fisher exact test, where appropriate. Results: Thirty-nine sets of triplets (117 infants) were delivered during the study period. Of these, 11 sets of triplets (28.2%) had a velamentous insertion of at least one umbilical cord. Infants with velamentous cord insertion were more likely to be small-for-gestational age than infants without velamentous cord insertion (33% vs 8%, P = .02). There were no significant differences in the rates of pregnancy complications between the two groups. Conclusion: Velamentous cord insertion is found frequently in triplet gestations and is significantly associated with small-for-gestational age in triplet neonates. (Am J Obstet Gynecol 2002;186:809-11.)


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pretorius DH
        • Chau C
        • Poelter DM
        • Mendoza A
        • Catanzarite VA
        • Hollenbach KA
        Placental cord insertion visualization with prenatal ultrasonography.
        J Ultrasound Med. 1996; 15: 585-593
        • Uyanwah-Akpom P
        • Fox H
        The clinical significance of marginal and velamentous insertion of the cord.
        Br J Obstet Gynaecol. 1977; 84: 941-943
        • Eddleman KA
        • Lockwood CJ
        • Berkowitz GS
        • Lapinski RH
        • Berkowitz RL
        Clinical significance and sonographic diagnosis of velamentous umbilical cord insertion.
        Am J Perinatol. 1992; 9: 123-126
        • Robinson LK
        • Jones KL
        • Benirschke K
        The nature of structural defects associated with velamentous and marginal insertion of the umbilical cord.
        Am J Obstet Gynecol. 1983; 146: 191-193
        • Antoine C
        • Young BK
        • Silverman F
        • Greco MA
        • Alvarez SP
        Sinusoidal fetal heart rate pattern with vasa previa in twin pregnancy.
        J Reprod Med. 1982; 27: 295-300
        • Pent D
        Vasa previa.
        Am J Obstet Gynecol. 1979; 134: 151-154
        • Fries MH
        • Goldstein RB
        • Kilpatrick SJ
        • Golbus MS
        • Callen PW
        • Filly RA
        The role of velamentous cord insertion in the etiology of twin-twin transfusion syndrome.
        Obstet Gynecol. 1993; 81: 569-574
        • Machin GA
        Velamentous cord insertion in monochorionic twin gestation: an added risk factor.
        J Reprod Med. 1997; 42: 785-789
        • Glinianaia SV
        • Skjaerven R
        • Magnus P
        Birthweight percentiles by gestational age in multiple births: a population-based study of Norwegian twins and triplets.
        Acta Obstet Gynecol Scand. 2000; 7: 450-458
        • Torrey WE
        Vasa previa.
        Am J Obstet Gynecol. 1981; 63: 146-152
        • Kouyoumdjian A
        Velamentous insertion of the umbilical cord.
        Obstet Gynecol. 1980; 56: 737-742
        • Heinonen S
        • Ryynanen M
        • Kirkinen P
        • Saarikoski S
        Perinatal diagnostic evaluation of velamentous umbilical cord insertion: clinical, Doppler, and ultrasonic findings.
        Obstet Gynecol. 1996; 87: 112-117
        • Bjoro K
        Gross pathology of the placenta in intrauterine growth retardation.
        Ann Chir Gynaecol. 1981; 70: 316-322
        • Mari G
        • Detti L
        • Oz U
        • Abuhamad AZ
        Long-term outcome in twin-twin transfusion syndrome treated with serial aggressive amnioreduction.
        Am J Obstet Gynecol. 2000; 183: 211-217