Abnormal Placental Cord Insertion and Adverse Pregnancy Outcomes: Results from a Prospective Cohort Study

Abstract

Objectives To prospectively measure the distance from the placental cord insertion (PCI) site to the placental margin using digital imaging and to examine the association between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies. Study Design This prospective cohort study examined 1,005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken and digital measurement was performed using ImageJ software. Results The rates of velamentous (insertion into the membrane) and marginal (<2 cm from placental margin) cord insertions in a total of 1,005 singleton pregnancies were 3.6% (n = 36; 95% confidence interval [CI] = 2.5–4.9%) and 6.4% (n = 64; 95% CI = 4.9–8.1%), respectively. Abnormal PCI was found to be more common among smokers compared with non-smokers (22.7 vs. 14.8%, p = 0.04). Abnormal PCI was found to be significantly associated with small for gestational age (adjusted odds ratio [OR]: 1.73; 95% CI: 1.01–2.97, p = 0.047) and low birth weight (adjusted OR: 3.87; 95% CI: 1.72–8.71, p = 0.001). Conclusion Digital imaging analysis using ImageJ software mapped the surface of the placenta and provided objective measurement of PCI site. In this large prospective cohort, abnormal PCIs were significantly associated with an increased risk of small for gestational age and low birth weight.

Risk Factors of Anomalous Cord Insertion Among Singleton Births at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

“…8 The Indian research, on the other hand, did not involve fetal abnormalities, which may have arisen as a result of ACI. 11 We found a statistically important strong positive correlation between maternal age and anomalous cord insertion in the current research. As a result, mothers over 35 years of age may face a nearly five-fold increase in the risk of ACI (Table 3).…”

Marginal cord insertion among singleton births at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

“…Abnormalities in the development and site of the insertion of the umbilical cord can cause problems that have the potential to affect maternal and fetal health and wellbeing [3]. Marginal cord insertion (MCI), with an incidence ranging from 2 to 25% [5], is thought to be associated with different risk factors like bleeding in pregnancy, advanced maternal age, pregnancies conceived with the aid of artificial reproductive technology, maternal chronic disease, and drug abuse during pregnancy [6].…”

“…Marginal cord insertion leads to intrauterine growth retardation (due to a decrease in blood flow to the developing fetus), low birth weight, low Apgar score [7], preterm labor, and development of velamentous type [6,8]. It is also a known risk factor for the occurrence of congenital abnormalities, compression of fetal vessels, and stillbirths (if MCI present in the cervical outlet of the uterus), and excessive hemorrhage (if associated with vasa praevia) [6]. Directions about MCI and related issues are expected from World Health Organization in general and the Ethiopian Federal Ministry of health in particular to solve associated problems.…”