Clinical Significance of Velamentous Cord Insertion Prenatally Diagnosed in Twin Pregnancy

Abstract

Background: The purpose of this study was to evaluate the prevalence of velamentous cord insertion (VCI) and the actual association between pathologically confirmed VCI and perinatal outcomes in twins based on the chorionicity. Methods: All twin pregnancies that received prenatal care at a specialty clinic for multiple pregnancies, from less than 12 weeks of gestation until delivery in a single institution between 2015 and 2018 were included in this retrospective cohort study. Results: A total of 941 twins were included in the study. The prevalence of VCI in dichorionic (DC) twins and monochorionic diamniotic (MCDA) twins was 5.8% and 7.8%, respectively (p = 0.251). In all study population, the prevalence of vasa previa and placenta accreta spectrum was higher in VCI group than that of non-VCI group (p = 0.008 and 0.022). In MCDA twins with VCI, birth weight, 1 and 5-min Apgar score were lower than DC twins with VCI (p = 0.010, 0.002 and 0.000). There was no significant association between VCI and selective fetal growth restriction (p = 0.486), twin-to-twin transfusion syndrome (p = 0.400), and birth-weight discordance (>20% and >25%) (p = 0.378 and 0.161) in MCDA twins. Conclusion: There was no difference in the incidence of VCI in twins based on the chorionicity. Moreover, VCI was not a risk factor for adverse perinatal outcomes excepting vasa previa and placenta accreta spectrum, which had a high incidence in twins with VCI.

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

“…117 Lee et al recently studied pathologically confirmed velamentous cord insertions and perinatal outcomes of 941 sets of twins with prenatal sonographic diagnosis, according to chorionicity. 116 The prevalence of velamentous insertion in dichorionic twins and monochorionic twins was 5.8% and 7.8%, respectively (P = 0.251). The prevalence of vasa previa and placenta accreta sequence was higher among patients with versus those without velamentous insertion (P = 0.008 and 0.022, respectively).…”

“…The incidence of velamentous insertion is increased among twin gestations. 106,107,116 Associated adverse perinatal outcomes of velamentous cord insertion among twins are reportedly higher than those associated with singleton gestations. 107 Fries et al in 1993 studied 38 cases of monochorionic-diamniotic twins were identified, 11 of which manifested as twin-twin transfusion syndrome.…”

Abnormal umbilical cord insertion and birth weight discordancy in monochorionic diamniotic twins: A retrospective study

“…However, we found that MCI was not an independent risk factor for birth weight differences in MCDAs, which is consistent with Lee. [14] Previous studies have shown that the incidence of MCI is about 8.5% in all pregnancies, 6.3% in singleton pregnancies and 10.9% in twin pregnancies, which is more common than VCI. [15] It is thought to be associated with different risk factors, such as pregnancy hemorrhage, advanced maternal age, pregnancies conceived with the aid of artificial reproductive technology, maternal chronic diseases and substance abuse during pregnancy.…”

“…However, some studies with relatively large sample sizes have drawn conflicting conclusions about the relationship between abnormal umbilical cord insertion in MCDAs and BWD and sFGR. Lee et al [ 14 ] evaluated the prevalence of VCI in twins and the actual association between pathologically proven VCI and perinatal outcomes based on choriostomy. Nine hundred and forty-one twins were included in the study, and the prevalence of VCI in DCDAs and MCDAs was 5.8% and 7.8%, respectively.…”

“…However, we found that MCI was not an independent risk factor for birth weight differences in MCDAs, which is consistent with Lee. [ 14 ]…”