Two vessel umbilical cord

[CathB]

I have just come back from my scan at which they have diagnosed a 2 vessel umbilical cord. I never knew there was any such thing, so I am a bit stunned to say the least. I gather there is no real reason to worry as everything else looks fine and the baby is the right size for dates but I have to go back next for another scan (doppler I think). I would really appreciate anyone else's experience of this phenomenon, as next week seems a long way off!

I can't be of any use about your problem but I do hate it when the professionals tell you something and then send you home to panic. As soon as you leave the room you start thinking of all the questions you wish you'd asked but didn't think of due to the shock. I'm sure everything will be ok because they didn't seem to be concerned for you or the baby so I shouldn't worry too much. Why don't you speak to your midwife if you need some reassurance?

CathB - I don't have personal experience of this, but have just found the following which explains things a bit. It looks as though if they can see no other problems, then you probably have nothing to worry about. Good luck with your scan.

'The umbilical cord normally contains two arteries and one vein. The vein is always present, because the baby could not survive without one. Therefore, the "two-vessel cord" is more appropriately called "single umbilical artery (SUA)".

The main reason there is a note made of it is that in up to 20% of cases, there will be another malformation seen. If there are none on a good anatomic survey by someone specializing in fetal ultrasound, the odds of any problem are very low.

The SUA is not particularly associated with chromosomal abnormalities unless other birth defects are seen.

If there is a malformation, it is frequently in the heart, so make sure that your doc is experienced in looking at fetal hearts. If not, ask to have a fetal echocardiogram by either a perinatologist or a pediatric cardiologist. But if the "4-chamber view" was normal, the odds of a heart defect are reduced by greater than 85%. A single umbilical artery does not usually, by itself, cause any problems - there is no bad effect from not having two arteries, but in a few cases, poor fetal growth has been associated with SUA. Frequent ultrasounds, every 3-4 weeks, can check the baby's growth.

If there aren't any other abnormalities, there is no effect on the baby's future development either - the umbilical arteries aren't needed after birth.

Sometimes the diagnosis is made in error. Color Doppler ultrasound of the area around the fetal bladder can show the blood flow in both arteries and confirm whether there is one artery or two. I've had a number of cases where the "plain view" was not conclusive and the color flow resolved the issue.'

Hi Azzie - isn't Google wonderful. Felt compelled to look it up too! Good news for Cath B.

Thanks! I have now done a little searching myself and am feeling a bit better as it all seems to tie up with what the radiographer told me. I think the consultant is checking it all again with doppler and will look at the heart in detail. I am not sure whether this is the same as a fetal echocardiogram but at least I know what to ask for!
PamT is quite right, it always seems fine until you get out into the carpark, your head clears and you think "but what about..."

This has made me remember something the midwife said when ds was born - when the placenta was delivered she was showing it to another midwife and I heard her say it was a "twin placenta" and the other midwife said she hadn't seen one before...It bothered me for a while afterwards (when I came out of my exhausted stupor) and I kept wondering if it meant my ds was "once" a twin? It sort of slipped to the back of my mind until now. From my searches on google (inspired by you - don't know why I hadn't thought of it before!) this would seem to be the most likely explanation...why wouldn't they tell me if this was the case? It was only that I overheard (in my drugged state)...has anyone else heard about this?

Oddly enough, my aunt (who is somewhat of a psychic) once told me I would have twin boys! Oh dear, this is really getting to me now...somebody please put me out of my misery one way or the other! Mears, where are you???

Mollipops, I'm not certain where I read this, may have been mumsnet somewhere, but I think if the 'twin' is officially recognised at birth it has to treated as a twin birth ie. the other baby has to be given a name, registered and have a death certificate. I think the general feeling is that this is so traumatic for a Mum who wasn't even aware that she was originally carrying twins that the best thing to do is not to officially notice. If this is rubbish I apologise. Be good to hear what Leese or Mears say.

Mollipops - really do not think you had a twin pregnancy at one point. Odd for the midwife to term the placenta a 'twin', and she should have expanded. I think she may have been referring to a 'bipartite' placenta. This is where two complete and separate lobes of the placenta are present, and each has a cord leaving it, but this bipartite cord joins a short distance from the two parts of the placenta, to become one cord, which joins the baby - sounds confusing I know, but is difficult to explain! This is nothing to do with a twin pregnancy where there are also two cords, but these do not join at any point. (Dependant on the type of twin pregnancy, there may be two separate placentae, or one placenta with two cords). A Bipartite placenta is rare, which would account for the midwife interest. Bluebear is also right, in that a twin pregnancy would have to be recognised as such, and recorded as such - it would not have been glossed over in this way. I think the midwife just used an unfortunate turn of phrase for an unusual placenta - you're unique!

Agree with Leese here. Don't know what the midwife meant. We get all excited about shaped of placentas and where the cord is inserted if it is on the unusual side. It may have been that she was explaining placentas to a student and referred to the differences of a twin placenta for some reason. Perhaps they had a twin delivery previously. Who knows. The reference would not be that you yourself had had a twin pregnancy at some stage otherwise you would most certainly know about it. Hope you feel reassured.

Thank you so much leese and mears, this has really played on my mind over the last few years, off and on. Leese, your bipartide placenta sounds like a reasonable explanation. None of my scans showed a twin pregnancy, the first at 16 weeks, and then I had quite a few around/after 27 weeks as I went into labour around that time. It stopped, thank goodness, but it took a while - and a week in hospital. So...sorry but I have to ask - if there had been a twin initially, say for the first month or so but then it didn't develop, would they be able to tell, or would it be "absorbed" somehow? If there was some evidence of it, would they mention it, or do as bluebear suggests and let it be? Sorry to harp on but this question is still niggling at me, I know I should be satisfied with your explanations and reassurances...

I have seen a number of placentas where, at the earliest scan there had been a twin identified. Often these women subsequently bled and 'lost' that baby, carrying the other one twin to term. That actually happened to one of my close friends.
If there has been no bleeding and in the early stages a twin dies then it is absorbed and there is no evidence of it after delivery.

I personally have never seen a placenta that had evidence of an undetected twin. If there was a question regarding ?twin, the placenta would be sent to pathology for examination.
With your history of having had 2 scans I really am sure that you did not have a twin pregnancy or you would have been told. Hope that is helpful.

Mollipops - my experience is the same as Mears'. A very early twin pregnancy, in which one twin did not survive from this point, would not be evident at delivery - ie. the placenta would not have continued growing to resemble a 'twin' placenta, had there been no twin to nourish. A later twin pregnancy, in which one twin did not survive WOULD be evident at delivery, but then it would also be evident at scan at 16 wks etc. As Mears pointed out, twin placentas (ie belonging to 'twins', not bipartite), are routinely sent off to Histology labs post delivery.
Sorry this is confusing - I read it and confuse myself!

Hi,
I am pregnant (with my 3rd) and although I don't have a question about a two vessel umbilical cord I do have a question regarding umbilical cords, which I am hoping someone might be able to answer!

My 1st child was breech and when she was delivered (by elective ceasarean), in my dreary and drugged state, a midwife/consultant/whoever told me that her umbilical cord had been attached to the side of the placenta and that it was a good job I'd had a ceasarean as it would have been likely that I would have had a hemmorage (sorry don't know correct spelling!!! But hopefully you know what I mean) and most likely have lost the baby. They also told me that she had a particularly thick umbillical which needed two clips rather than one. I don't know if this is connected or whether it would mean there are any related dangers, but my question is, is this likely to happen with my current pregnancy? (It didn't with my 2nd child) And if so what should I do? I would really appreciate someone's advice on this as it is a worry with my current pregnancy.

Many thanks
Adele

Hi Adele - what a stupid thing for the consultant/midwife to say (sorry - the lack of bedside sensitivity displayed sometimes gets to me).
First, let me explain what was probable with the placenta. After every delivery, the midwife thoroughly checks the placenta - checking cord vessels, that there are two membranes surrounding the placenta which separate, that the placenta and membranes are 'complete' (ie, no bits left inside), and she also notes whereabouts the cord is inserted into the placenta. Usually this is fairly central, but sometimes the position of the cord deviates a little or a lot, and can basically be anywhere on the placenta. I imagine your consultant was referring to either a 'velamentous cord insertion'or a 'battledore cord insertion' - and yes, these can lead to increased blood loss in certain cases, but in no way mean you would have lost your baby.
DEFINITIONS:

1. Velamentous cord insertion: Cord is inserted into the membranes rather than the placenta, some distance from the edge of the placenta. This means the vessels found in the cord run thru the membranes to the placenta. Even in a normal labour, this will only cause a problem if the placenta is lying very low, near the cervix (and most placentas aren't) - imagine then that the cord vessels run thru the membanes which are in front of the baby's head - the ones which rupture when your waters break, or are broken for you (this is termed vasa praevia - similar to placenta praevia). If these membranes rupture, there is a risk that the vessels may be torn, and this would result in haemmorhage - delivery then should follow quickly or else the baby would be at great risk. If a woman labours with this sort of placenta/cord and waters remain intact, a midwife should be able to feel the vessels on vaginal examination, and a decision can then be made about mode of delivery. Velamentous cord insertions are rare - I have only ever looked after one lady with this, and diagnosed it on vaginal exam. Remember too that most placentas do not lie low near the cervix, so ruptured membranes would then not be a problem.
   The third stage could be problematic, as if the midwife applies traction to the cord to pull it out (as in a managed third stage), the cord coud then become detatched, resulting in greater blood loss, which would be stemmed by the midwife. Obviously this poses no risk to your baby at this point.

2. Batttledore cord insertion: Also rare. In this case, the cord is attached at the very edge of the placenta (bit like a table tennis bat). This is not really important, unless the cord attachment is very fragile, in which case the cord could also detach during the third stage (as mentioned above).

It is important to say Adele that each placenta is unique. There is nothing about you which makes you susceptible to velamentous cords or otherwise - that was just the way your placenta formed. The next one will be totally different. As for a thick cord - that again is nothing to worry about, and means nothing. Cords come in all shapes and sizes - the bigger ones often belong to healthier placentas, and vice versa. The fact it needed two cord clamps is irrelevant

Long answer, but hope it answers your query.

Thanks Leese for the information, though it is all a little complicated for a someone like me who doesn't know a lot about these things! You are obviously very thorough and you have put my mind at ease. Thank you for that. Sometimes these midwives etc. say these things not realising they are frightening us so much with their words.
All the best
Adele

I thought you might be interested in the update on the two vessel cord thing. I have had my additional scan (with a cast of thousands in attendance I may say) and everything appears to be fine particularly the heart which is a huge relief. There are apparently no implications for delivery but I will have to have regular growth scans to check this one is growing ok. Ironically I also have to have a glucose tolerance test as dd was a whopper, which I guess covers most eventualities.

Sounds like you'll be getting a parking space with your name on at the hospital then I'm glad that everything is ok, fingers crossed that it is plain sailing right through to the arrival.

Hi there.

I realise that this is an elderly posting, but as it is still accessible I am rather concerned about some of the advice.

The reply from leese implies that velamentous inseryion of the cord "can lead to increased blood loss in certain cases, but in no way would you have lost your baby". I have to say that this is ill-informed advice. Has leese ever heard of vasa praevia? I think not from her reply. Why do I ask when she mentions it in her reply? Well, to put not to fine a point on it, she has no idea what vasa praevia is! VP is NOT "similar to placenta praevia" and a midwife, unless she is highly trained would not necessarily "be able to feel the vessels on vaginal examination". This reply is really worrying in the extreme. Yes, velamentous insertion, as with vp, is rare. The incidence of vp has now been proven by recent research to be 1:2,500 pregnancies. However, when it is not diagnosed prenatally, 96% of babies with VP will bleed to death! In VP the vessels from the plaventa lie across the opening to the cervix. These then rupture during labour/ARM leading to rapid foetal exsanguination. Perhaps leese should visit the website of the International Vasa Previa Foundation, based in the US, to find out all about VP and I would urge other women to learn all they can as well. There is currently no duty of care in the UK for women to be scanned for this rare and avoidable complication of pregnancy. The largest ever study in to vp was published in May 2004. If you want to find out more accurate information then go along to the website this . It will be a worthwhile visit. Believe me, my daughter survived!

When I gave birth to my oldest in 95 I had two placentas and umbilical cords. The midwife never told me why. On my ex's side twins never skip a generation but they never survive either. Now my daughter who's 21 is expecting on the same day that I was that year with her first a little girl and had genetic testing done found out she's a vanishing twin which causes this. Having this from what I read is rare. Here's the article.
synapse.koreamed.org/Synapse/Data/PDFData/2021KJOG/kjog-55-664.pdf

Vanishing twin isn't rare the two placentas and umbilical cords are. The only thing I can think of since women determine twins are I probably was a vanishing twin myself. I always said that my oldest absorbed his twin. My mom's doctor thought she was having twins with me and on the delivery day, they did an ultrasound to make sure I was the only one.
I do know that this post is old but I know for myself for years I have been searching for answers. I hope this helps.