What are the novel findings of this work?There is conflicting evidence regarding the relationship between peripheral cord insertion and pregnancy outcome. This study used detailed placental pathology and found peripheral cords are most common with maternal vascular malperfusion; however, adverse pregnancy outcome is associated with pathology within the placenta, not with the cord insertion. What are the clinical implications of this work?These findings suggest that patients with peripheral cord insertion, normal Doppler ultrasound and normal circulating placental growth factor levels are at low risk of adverse outcome, and additional fetal surveillance is not justified.