Second trimester marginal cord insertion is associated with adverse perinatal outcomes

Allaf, M. Baraa; Andrikopoulou, Maria; Crnosija, Natalie; Muscat, Jolene; Chavez, Martin; Vintzileos, Anthony M.

doi:10.1080/14767058.2018.1453798

Cited by 26 publications

(41 citation statements)

References 22 publications

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“…The placental cord insertion site, an element of the standard second‐ and third‐trimester fetal ultrasound (US) examination, may be identified in 99% to 100% of unselected pregnancies with grayscale and color Doppler US . Velamentous cord insertions, or cord insertions into the fetal membranes, affect 0.6% to 1% of pregnancies and are associated with significantly increased frequencies of poor outcomes, even in the absence of a coexisting vasa previa …”

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confidence: 99%

Second‐Trimester Ultrasound‐Measured Umbilical Cord Insertion–to–Placental Edge Distance: Determining an Outcome‐Based Threshold for Identifying Marginal Cord Insertions

Wax

Cartin

Craig

et al. 2019

J of Ultrasound Medicine

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Objectives We sought to study potential diagnostic criteria for marginal placental cord insertions as determined by associations with obstetric outcomes. Methods This single‐center retrospective cohort investigation included singleton gestations delivering from January 1, 2012, to December 31, 2016, and having a standard or detailed fetal ultrasound examination from 18 weeks to 21 weeks 6 days. Cord insertion–to–placental edge distances were used to create a referent comparison group and 3 patient groups: greater than 3.0 cm (comparison); greater than 2.0 to 3.0 cm (group 1); greater than 1.0 to 2.0 cm (group 2); and 1.0 cm or less (group 3). The primary outcome consisted of any one of spontaneous delivery before 37 weeks, fetal growth restriction, oligohydramnios, placental abruption, or intrauterine fetal demise. Results The numbers of participants and mean distances ± SDs for the comparison group and groups 1 to 3, respectively, were 628 and 4.68 ± 1.17 cm, 106 and 2.52 ± 0.26 cm, 131 and 1.60 ± 0.29 cm, and 77 and 0.36 ± 0.37 cm, respectively. The primary outcome was significantly associated only with cord insertion–to–placental edge distances of 1.0 cm or less (adjusted odds ratio, 3.05; 95% confidence interval, 1.73–5.38). Conclusions Marginal cord insertions may be diagnosed when the cord insertion–to–placental edge distance is 1.0 cm or less.

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confidence: 99%

Second‐Trimester Ultrasound‐Measured Umbilical Cord Insertion–to–Placental Edge Distance: Determining an Outcome‐Based Threshold for Identifying Marginal Cord Insertions

Wax

Cartin

Craig

et al. 2019

J of Ultrasound Medicine

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“…The available evidence does not support this conclusion. The placental cord insertion site may be identified in 99% to 100% of consecutive unselected pregnancies on grayscale and color Doppler ultrasound imaging, even during the first trimester . In one series of 549 singletons, 548 (99.8%) cord insertions were visualized.…”

Section: Current Guidance and Recommendations For Changementioning

confidence: 99%

“…A marginal cord inserts eccentrically into the placental parenchyma and affects 5.2% to 11.3% of pregnancies (Figure ) . The variation in the reported frequency likely reflects both the arbitrarily selected diagnostic thresholds of cord–to–placental edge distances, which range from 1 to 3 cm, and whether the distance was measured by prenatal ultrasound or postdelivery placental examination . These same factors are also likely responsible for the variable association of marginal cord insertions with pregnancy complications.…”

Section: The Rationale For Imaging the Placental Cord Insertion Sitementioning

confidence: 99%

“…1,2 The variation in the reported frequency likely reflects both the arbitrarily selected diagnostic thresholds of cord-to-placental edge distances, which range from 1 to 3 cm, and whether the distance was measured by prenatal ultrasound or postdelivery placental examination. [1][2][3][4][5][6][7][8][9][10] These same factors are also likely responsible for the variable association of marginal cord insertions with pregnancy complications. Rather than identifying marginal cord insertions by arbitrary cutoffs or postdelivery assessments, a clinically meaningful threshold would be derived from the relationship between second-trimester ultrasound examinations and relevant obstetric outcomes.…”

Section: The Rationale For Imaging the Placental Cord Insertion Sitementioning

confidence: 99%

“…The placental cord insertion site may be identified in 99% to 100% of consecutive unselected pregnancies on grayscale and color Doppler ultrasound imaging, even during the first trimester. 1,2,[27][28][29] In one series of 549 singletons, 548 (99.8%) cord insertions were visualized. Among the 531 patients for whom the scanning time was recorded, the mean imaging time AE SD required to examine both the fetal abdominal and placental cord insertions was 41.5 AE 46.7 seconds.…”

Section: Current Guidance and Recommendations For Changementioning

confidence: 99%

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Imaging the Placental Cord Insertion: Just Do It

Wax

Pinette

2019

J of Ultrasound Medicine

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

Ward

Sun

Maresse

2023

Australas J Ultrason Med

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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.

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Second trimester marginal cord insertion is associated with adverse perinatal outcomes

Abstract: Evaluation of PCI is feasible in all cases. Second-trimester MCI is associated with increased likelihood for LBW, PTD, and composite adverse obstetrical and neonatal outcomes.

Cited by 26 publications

References 22 publications

Second‐Trimester Ultrasound‐Measured Umbilical Cord Insertion–to–Placental Edge Distance: Determining an Outcome‐Based Threshold for Identifying Marginal Cord Insertions

Second‐Trimester Ultrasound‐Measured Umbilical Cord Insertion–to–Placental Edge Distance: Determining an Outcome‐Based Threshold for Identifying Marginal Cord Insertions

Imaging the Placental Cord Insertion: Just Do It

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

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