Overview

• Foetal vessels run close to the the internal cervical os → vessels at risk of rupture when membranes rupture.
• Aetiology ⇒
  • Velamentous cord insertion → umbilical cord inserts into foetal membranes instead of middle of placenta, then travels with the membranes of the placenta.
  • Accessory placental lobes.
• Risk Factors → foetal anomaly (bilobed placenta), history of low-lying placenta in 2nd trimester, multiple pregnancies, IVF.

Making Diagnosis

Clinical Features

• Classic Triad ⇒ membrane rupture followed by PV bleeding (painless) + foetal bradycardia (or resulting foetal death).
• ‘Succenturiate Lobe’

Investigations

• Doppler Ultrasound.

Management Plan

• Emergency (category 1) C-section.

Complications → foetal death (no major maternal risk).

Prognosis → 50% perinatal mortality (increases to 75% if membranes ruptured).