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Velamentous Cord Insertion (VCI) is an abnormality of the umbilical cord where the umbilical vessels insert into the fetal membranes (amnion and chorion) rather than directly into the placental disc. This leaves the unprotected vessels vulnerable (not surrounded by Wharton’s jelly) as they traverse the membranes before reaching the placenta.

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Epidemiology

📊 Incidence

Occurs in 1% of singleton pregnancies
Up to 15% in monochorionic twins
More common in IVF pregnancies, multiple gestation, and with placenta previa

Pathophysiology

Normally, the umbilical cord inserts centrally or eccentrically into the placenta.
In VCI, the vessels separate early and are exposed within the membranes, increasing the risk of compression, rupture, or thrombosis.

Complications

Complication	Details
Vasa previa	Fetal vessels cross the cervical os, at risk of rupture during labor.
Fetal hemorrhage	Rupture of unprotected vessels may lead to rapid fetal exsanguination.
IUGR / SGA fetus	Due to poor placental perfusion.
Preterm labor	Triggered by placental or membrane complications.
Abnormal Dopplers	Elevated umbilical artery resistance indices may be seen.

Radiology

US imaging (typically second trimester)

https://youtu.be/ZYGH10cMuQk

Color Doppler reveals:
- Umbilical vessels traversing membranes before reaching the placental edge
- Insertion of vessels into membranes rather than directly into the placental mass