Velamentous insertion of the umbilical cord

Vas previa remains one of the most unexpected and tragic accidents in obstetrics. The diagnosis is rarely made before delivery and, even when the condition has been recognized during labor on rare occasions, the fetal mortality has been extremely high. The fact that the fetus is at maximum risk while there is no maternal hazard at all makes this condition unique in obstetrics and demands that management be directed exclusively toward saving the baby. From a review of the literature an attempt has been made to see whether modern techniques of prenatal and intrapartum care can be used to improve the fetal salvage rate. This report also includes the report of a case with the usual fatal fetal outcome. A second case of velamentous insertion of the cord associated with a bilobed placenta is also reported. From 54 cases reported in the literature since 1952, it appears that the fetal mortality is likely to remain very high in this condition, at least for the foreseeable future.