Q: Dear Dr Fong

My sister-in-law lost her baby at 31 weeks, and delivered the stillborn baby at 32 weeks. No autopsy was done, but from the gynaecologist's physical examination, it seems that the umblical cord emerged from the side, instead of growing from the centre of the placenta. The width of the cord was also narrowed towards the baby.

The doctor told the couple that the stillbirth might have been due to these reasons but she cannot be certain.

I have been surfing the Web, and came across a condition called velamentous cord insertion, where the umbilical cord inserts into the side of the placenta. I think my late niece could have been suffering from this.

From what I have gathered, this condition could have been detected during the ultrasound scans. Is this true? Could it really have been detected early?

Mrs Ong

A: Dear Mrs Ong,

It is difficult to ascertain your late niece's condition without detailed examination and consultation.

But from your description of the placenta and cord insertion, it is possibly a "battledore placenta", not a "velamentous cord insertion".

A battledore placenta - when the umbilical cord is attached at the side, instead of the centre of the placenta, is usually an incidental finding with no clinical implication. It is not a cause for stillbirth.

Even a velamentous insertion of cord - where the cord inserts itself into the membrane of the placenta and not the placenta itself, is not a cause of stillbirth.

When velamentous cord insertion happens, it might result in vasa praevia* and bleeding from the cord at the time of labour. Only in this situation will foetal exsanguination** and "fresh" stillbirth occur.

In this situation, the unusual narrowing or "stricture" of the cord could have been responsible for this particular instance. But this condition would not be detectable on routine prenatal ultrasound examinations.

However, the cause of stillbirth remains unidentifiable in 40-50 per cent of cases despite extensive investigation and autopsy.

*Vasa praevia - a condition which occurs when one or more of the baby's placental or umbilical blood vessels cross the entrance to the birth canal beneath the baby. (See http://www.vasapraevia.co.uk).

**Exsanguination - It is the extensive loss of blood due to internal or external haemorrhage. (See http://medical-dictionary.thefreedictionary.com).

This week's question was answered by Associate Professor Arijit Biswas, Senior Consultant and Dr Fong Yoke Fai, Consultant, Department of Obstetrics & Gynaecology at the National University Hospital.

Got a question on pregnancy or your reproductive health? Email it to us at Just Woman and we will get it answered by Dr Fong Yoke Fai, a consultant Obstetrician and Gynaecologist at the National University Hospital.
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