Objective: Velamentous insertion of the umbilical cord, with a reported incidence of 1% in singleton pregnancies, has been associated with several obstetric complications including fetal growth restriction, prematurity, congenital anomalies, low Apgar scores, fetal bleeding and retained placenta. The aim of this study was to determine the feasibility of identifying velamentous insertion of the umbilical cord during routine obstetric ultrasound.Design: This was a prospective, cross‐sectional ultrasound study in 832 unselected second‐ and third‐trimester singleton pregnancies. Color Doppler ultrasound was routinely performed to identify the placental cord insertion site. The role of three‐dimensional (3D) ultrasound in evaluating the placental cord insertion site was also studied in a subset of 50 pregnancies from this population.Results: The placental cord insertion site was identified in 825/832 (99%) cases. Visualization was not achieved in seven third‐trimester pregnancies with a posterior placenta. A velamentous insertion was suspected prenatally in eight cases, seven of which were confirmed after delivery as velamentous and one as markedly eccentric (battledore placenta). 3D ultrasound performed poorly at evaluating placental cord insertion site, being less efficient due to poor‐quality resolution and far more time‐consuming than the combined use of gray‐scale and color Doppler ultrasound.Conclusions: Velamentous insertion of the umbilical cord can reliably be detected prenatally by gray‐scale and color Doppler ultrasound. 3D imaging had limited value in the evaluation of the placental cord insertion site in our subset of patients. Systematic assessment of the placental cord insertion site at routine obstetric ultrasound has the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications including vasa previa. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

To review the prenatal complications, management, and perinatal outcome in pregnancies complicated by placental chorioangioma. Cases of placental chorioangioma diagnosed prenatally as part of a prospective, multicentric program for fetal diagnosis and therapy were identified. All cases were evaluated with color flow imaging. In the latter part of the study, three-dimensional power Doppler angiography was also used to study the vascular pattern of the tumor. Information on maternal demographics, prenatal sonographic findings, pregnancy complications, antenatal intervention, and perinatal outcome was obtained by reviewing the medical records or contacting the referring obstetricians. In the 5-year period from January 1997 to December 2001, 11 cases of placental chorioangioma were diagnosed prenatally. Nine cases were diagnosed in singleton and two in twin pregnancies. Among the nine cases occurring in singletons, five (56%) were associated with pregnancy complications, including polyhydramnios (n = 3), oligohydramnios (n = 2), fetal growth restriction (n = 2), and nonimmune hydrops (n = 1). Amniodrainage was required in one of these cases, allowing prolongation of pregnancy until term. Four (44%) singletons delivered before 35 weeks. Overall, two fetuses died, including one twin due to complications of twin-twin transfusion syndrome and another with hydrops after alcohol injection into the chorioangioma. In four pregnancies, no prenatal complications were detected in spite of continuous growth and vascularity of the placental mass in three of them. Placental chorioangioma is associated with an increased risk of pregnancy complications, the most common being polyhydramnios and preterm delivery. In selected cases, amniodrainage allows continuation of the pregnancy with improving perinatal outcome. Fetuses who develop hydrops are at the highest risk for perinatal death, with limited therapeutic options being available. Close follow-up is advised, even in those cases with no associated findings at the time of the diagnosis.