Current practice of placental cord insertion documentation in Australia – A sonographer survey

Abstract

IntroductionDuring pregnancy, the umbilical cord attaches to the placenta in a central, eccentric, marginal or velamentous location. Maternal and fetal complications are associated with marginal and velamentous cord insertions, the most clinically significant being perinatal mortality due to undiagnosed vasa praevia. Current literature describes a wide variation regarding regulation of placental cord insertion (PCI) documentation during antenatal ultrasound examinations. This prospective cross‐sectional study aimed to assess the current practice of antenatal PCI documentation in Australia.MethodsMembers of the Australian Sonographer Accreditation Registry were invited to participate in an online survey which was distributed between February and March 2022.ResultsFour hundred ninety sonographers met the inclusion criteria for the study of which 330 (67.3%) have more than 10 years' experience as a sonographer and 375 (76.5%) are employed primarily in a public or private setting offering general ultrasound. Most respondents (89.6%) indicated documentation of the PCI site is departmental protocol at the second trimester anatomy scan (17–22 weeks gestation), but PCI documentation is protocol in less than 50% of other obstetric ultrasound examinations listed in the survey. The PCI site is included in the formal ultrasound report at a rate significantly less than inclusion in the departmental protocol and the sonographer's worksheet.ConclusionsConsidering the potential maternal and fetal complications associated with abnormal PCI and the ease at which the PCI site is identified in the first and second trimesters, we believe that standard inclusion of the PCI site in departmental protocol and in the formal ultrasound report from 11 weeks gestation, regardless of whether it is normal or abnormal, would prove invaluable.

Incorporation of vasa previa screening into a routine anomaly scan: A single center cohort study

“…A recent survey of obstetric sonographers in Australia found that 89.3% responded that it was departmental protocol to routinely document placental cord insertion. 36 Assessment of the placental cord insertion at 20 weeks is recommended by the USA consensus; 37 , 38 to this we would add the routine assessment of the region over the cervix for fetal vessels as was done in our algorithm.…”