PLACENTAL CORD INSERTION ABNORMALITY, A CAUSE FOR ASSYMETRICAL IUGR WITH PIH

The incidence of velamentous insertion of the umbilical cord is about 1% in singleton pregnancies. Prevalence of velamentous insertion of the umbilical cord is approx 0.22 % worldwide. Prenatal diagnosis of velamentous insertion of the umbilical cord is of practical importance since unsupported vessels in the amnion may be lacerated at the time of membrane rupture. Failure to diagnose ruptured vessels can lead to fetal death. This mode of insertion occurs much more frequently with multi-foetal pregnancies. We present a case of 32 yrs old women who presented with amennorrhoea for 8 months. With history of previous first trimester abortion, she was found to be of 34 weeks gestational age, clinically. USG revealed fundo-posterior right lateral grade 3 placenta with no retroplacental clot or infarction. Biophysical profile score was 6-8 and Doppler showed uteroplacental & foetoplacental insufficiency. Emergency caesarean section was done on 2/5/2013, which revealed placenta-cord to be thin with normal length but cord insertion was 5cm away from placental margin. Female baby of 2kg weight was delivered by vertex who cried immediately. APGAR score was 7 at birth and 8 after 5minutes. Newborn had no congenital anomalies