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Is VAGINAL DELIVERY safe with VELAMENTOUS CORD INSERTION?

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Hi there, I am hoping to receive more information about a finding on our baby's recent ultrasound. To give you a little background information, I am being regularly monitored for fetal growth due to having a velamentous cord insertion, which can hinder the growth of a fetus. So, I get regular ultrasounds. I also have a succenturiate placenta. Anyway, I am currently at the very end of the 35th week of pregnancy, and yesterday we were told that there was a fluid filled loop in the baby's bowel. The perinatologist was very quick about telling us and just said that it could be nothing to worry about. I have been trying to google this and see that it can also be a bowel obstruction requiring surgery. I was just hoping for more information about what this may or may not mean, and how serious it is. I'm feeling really anxious for the health of my baby and I cannot get in to see my OBGYN until the end of next week, which feels far away at the moment. I've also been stressing about the safety of a vaginal delivery considering the fragility of the velamentous cord insertion, although there is no evidence of vasa previa present. Thanks in advance for your help! Looking forward to hearing back from you.

Category: OBGYN

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Category: Infertility Specialist
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Hello,
Thanks for posting your query at DoctorSpring.com
Would you mind uploading the scans done so far, particularly the most recent one ?
I can understand it would be cumbersome uploading all images,just the reports also would do.
I would prefer to opine after going through them.
Also, is this your index ( first ) pregnancy ?
What is your height and weight ?
Apart from the findings on the ultrasound scans, do you have any other factors complicating your pregnancy ?
Looking forward to hearing from you with the details.
Take care.
Regards.


Patient replied :

Hello again, unfortunately I do not have access to the scans or the report. In Canada they do not provide us with these things - they only tell us the information. What we were told was that there was a single, fluid-filled loop in the bowel. The doctor said it's often nothing to worry about. However, he said it will be important to ensure that our baby has a bowel movement and passes gas normally upon delivery.
Around the 20 week mark there was a bright spot seen on the bowel (echogenic bowel). However, it was gone by the next ultrasound and not seen again. During this time, I requested to be tested to see if I was a carrier of Cystic Fibrosis, as I read that this could cause such a thing. Luckily, I was not a carrier. I'm not sure if that's relevant or not.
In addition to the velamentous cord insertion and the succenturiate placenta, I also have abnormal auto-antibodies in my immune system. Specifically, I carry SSA and am positive for ANA, suggesting primary Sjorgren's Syndrome. I have never had many symptoms. They have watched the baby closely for signs of fetal heart block, as there was a small chance of this occuring due to the SSA auto-antibodies, mainly from weeks 18-25. However, all has been good. I am otherwise healthy.
I am 5'2" tall and currently weigh 145 lbs at approximately 36 weeks gestation. Prior to pregnancy, I weighed 120 lbs, so have gained 25 lbs total to date. This is my first pregnancy. Hope that helps a little!
Kind regards,
Krista


Hello again.
I would have really preferred to go through the scans.
As that is not possible according to you, I am offering my opinion based on the information provided by you.
A single, fluid filled bowel loop is not ominous at all.
You have not specified if it is the small bowel or large bowel.
The small bowel ( ileum ) commonly shows fluid filled spaces in the third trimester.
Intestinal obstruction is suspected when multiple fluid filled and distended bowel loops are seen, which is not the case at all.
Velamentous cord insertion triples the risk of adverse fetal outcomes, so you are right in being apprehensive about a vaginal birth.
It should be attempted only at a tertiary centre well equipped with systems for meticulous fetal monitoring and facilities for prompt cesarean birth if required.
Also, a succenturiate placenta requires vigilant observation post birth too, for complete expulsion of the placenta.
If these criteria are met, and your OB - GYN is familiar with your risk factors, a vaginal birth maybe attempted.
All the best
Please feel free to discuss further.
Regards.


Patient replied :

Hi there! Thanks for your answer. I feel comforted in knowing that the single fluid filled loop is likely nothing to be concerned about. That is, of course, what the perinatologist said as well, however, I just wondered why he bothered to inform us of it at all then, and it is always nice to get a second opinion. I have a follow-up with my OB-GYN this thursday, and I will ask for details about the location of the loop and then relay this information to you if that's ok? As for the velamentous cord insertion, I do know of the risks and I am scared of them. The hospital where I will deliver is the best in the area and is a facility for "high risk" pregnancies, so I know that I am in good hands. They are giving me the choice of doing a vaginal delivery or a c-section. They seem to think that I should opt for a natural, vaginal delivery, as the odds are very low of something bad happening. However, I hate the thought of having ANY extra risks and feel inclined to ask for a c-section. What I'm most worried about is the cord rupturing or becoming detached during labor and the baby losing her blood/oxygen supply in a matter of seconds. They said that this is very unlikely but it is in theory possible. Do you think it's better to just go for a c-section than incur the risks (although small, still present) of labor? I'll send you more info at the end of the week about the loop to see what you think. Thanks again for your help, I appreciate it! Krista


Dear Krista
Thank you for the appreciation.
Will await details of the cord.
Regarding the cord issues, yes theoretical risks exist, but in a responsible set-up, you can attempt vaginal birth..
Is this your first pregnancy ?
Regards.


Patient replied :

Hello again,
Thanks for your patience! I saw the doctor today and there was not even mention of the bowel in the report sent to her by the perinatologist, so there must not be anything worth noting. They didn't even mention the fluid filled loop, so it must be normal I guess. Good! One less thing to worry about. And yes, this is my first pregnancy (thus all the worrying!)
In terms of the velementous cord insertion, do you think it's a good idea to elect for a c-section or attempt the vaginal birth? I know that a vaginal birth is always preferable, but I just want so badly for my baby to be safe. I don't mind having a longer recovery to ensure her safety. I read on the Internet about a women who had a velamentous cord and it ruptured during labor, so her baby bled to death in seconds - with not time for intervention. I am petrified of this happening. The doctors say it's such a small risk that I should probably have a vaginal birth, but I just feel so worried. What would you do if you were in my position? I think they will respect whatever choice I make. In addition, my doctor said during an earlier pelvic exam that I was on the small side and I might get stuck during vaginal delivery around 6 cm of dilation. But he said that we would check me again at 38 weeks to see if that's changed. I just feel like if there's a chance of that as well, then wouldn't it be better to simply opt for the c-section and eliminate the other risks to the baby as well? Is it really that awful to have a c-section? I'm not scared of the pain in either scenario, all of my concern is for my baby. Thanks in advance for your opinion. After I get it I will close the conusltation :)


Hello
Thanks for the update.
True pelvic assessment can be made only after 38 weeks of pregnancy, it is too early to opine about the pelvis size.
Am glad the bowel loop issue is out of the way at least.
Regarding the velamentous cord, those risks are small, but theoretically possible, and there is no way of predicting if you would make up that dreaded small percentage or the significantly vaster normal populace.
You have posed a tough question.
As a doctor, I would urge you to opt for vaginal birth at a reliable centre.
As a woman and mother, I would opt for a c section.
It is not at all awful.
I perform numerous sections daily, and it is not as morbid as you think.
I have personally had one ( for my twins who were both breech ) and it is perceived as more comfortable for the mother than a vaginal birth.
There are attendant risks with surgery too , but if I had to choose ( leaving aside my professional aspect ) I would opt for an elective C section and a safe baby home, rather than go for labour with dreaded visions.
I have been as honest as possible.
Hope it helps.
In the end, we are informants and guides, the choice is yours.
May God be with you, whatever you choose.
Take care.
Never hesitate to approach me again, whenever you wish to.
Regards.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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