Grand Rounds

Is There Data to Support Cord Insertion Visualization on Prenatal Ultrasound?

BACKGROUND AND PURPOSE:

Velementous cord insertion (VCI) is defined as vessels that insert into the chorioamniotic membranes and are covered only by amnion and chorion before reaching the placenta
- Occurs in approximately 1% of singleton pregnancies
Marginal cord insertion (MCI) is defined as insertion <2cm from placental margin
- Occurs in approximately 7% of singleton pregnancies
Using digital imaging, Ismail et al. (American Journal of Perinatology, 2017), measured placental cord insertion (PCI) site – placental margin distance post-delivery to determine accurate associations between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies

Prospective Cohort Study
Singletons
1,005 placentas from consecutively delivered placentas
Adjusted for known risk factors
Digital imaging camera and software following delivery allowed for placental surface mapping and a more objective measurement of PCI site

6% of placentas had velamentous cord insertions
4% of placentas had marginal (2cm from placental margin) cord insertions
Abnormal PCI was more common among smokers compared to non-smokers
- 7 vs. 14.8%, P = 0.04
Abnormal PCI was significantly associated with
- Small for gestational age (SGA) defined as birth weight of less than the 10th percentile for gestational age
  - Adjusted odds ratio [OR]: 1.73; 95% CI 1.01–2.97, P = 0.047)
- Low birth rate (<2,500 g)
  - Adjusted OR: 3.87; 95% CI: 1.72–8.71, p = 0.001
- Preterm birth (<37 weeks)
  - 1 vs. 5.1%, p = 0.04

Abnormal PCIs were significantly associated with an increased risk for SGA and low birth rate
PCI site can be identified on prenatal ultrasound and the authors suggest that this should be encouraged to identify pregnancies at higher risk for SGA and low birth weight

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