Imaging the Placental Cord Insertion: Just Do It

Wax, Joseph R.; Pinette, Michael G.

doi:10.1002/jum.15143

Cited by 3 publications

(9 citation statements)

References 32 publications

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“…8 Several authors suggest documenting the PCI site as early as the 11-to 14-week ultrasound 1,31,42,44 whilst others advocate routinely visualising the PCI site during every ultrasound examination performed. 10,25 Our experience has shown ease of documentation of the PCI site at all gestations in most cases (Figures 1-6).…”

Section: Ultrasound Of the Pcimentioning

confidence: 92%

“…Current literature documents the incidence of the PCI site in singleton pregnancies as >90% for normal insertion, 7 4.2%-11.3% for marginal insertion 2,3,[5][6][7][8]10,11,15,16,18,20,32,37,39 and 0.4%-2.4% for velamentous insertion. 2,3,[5][6][7][8]10,11,13,[15][16][17][18]20,22,32,34,35,[39][40][41] The diversity in the reported frequency of abnormal PCI may be due to the variety of definitions of MCI and whether the PCI site was measured on antenatal ultrasound or on pathologic examination. 10 Whilst the current literature advocates antenatal ultrasound assessment of the PCI, 10,25 to our knowledge, no studies have been performed to determine how frequently ultrasound localisation of the PCI translates into formal documentation of the PCI site.…”

Section: Clinical Significance Of the Placental Cord Insertion (Pci) ...mentioning

confidence: 99%

“…2,3,[5][6][7][8]10,11,13,[15][16][17][18]20,22,32,34,35,[39][40][41] The diversity in the reported frequency of abnormal PCI may be due to the variety of definitions of MCI and whether the PCI site was measured on antenatal ultrasound or on pathologic examination. 10 Whilst the current literature advocates antenatal ultrasound assessment of the PCI, 10,25 to our knowledge, no studies have been performed to determine how frequently ultrasound localisation of the PCI translates into formal documentation of the PCI site. This study assessed the extent to which the PCI is included in the departmental protocol, the sonographer worksheet and in the formal report during obstetric ultrasound examinations in Australia.…”

Section: Clinical Significance Of the Placental Cord Insertion (Pci) ...mentioning

confidence: 99%

“…Vasa praevia U 14,17,[22][23][24][25][26] 65.1 27 Fetal/perinatal mortality 7,8,13,16,22,25,[28][29][30][31] 2.14 7 Low birth weight U 1,3,5,7,8,10,16,18,20,21,28,32,33 1.24 7 (birth weight <10th centile) 2,5,8,13,16,18,22,28,29,[33][34][35][36] 1.88 7 (birth weight <10th centile)…”

Section: Marginal Cord Insertion Odds Ratio Velamentous Cord Insertio...mentioning

confidence: 99%

“…The umbilical cord inserts into the placenta in a central, eccentric, marginal or velamentous fashion 1–6 . Marginal cord insertion (MCI) has been variously characterised in the literature with definitions cited as <2.5 cm, 7 <2 cm, 2,5,8 and ≤1 cm from the placental edge 6,9–11 . Eccentric cord insertion is most commonly defined as a lateral insertion >2 cm from the placental edge 12 .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Ultrasound Of the Pcimentioning

confidence: 92%

Section: Clinical Significance Of the Placental Cord Insertion (Pci) ...mentioning

confidence: 99%

Section: Clinical Significance Of the Placental Cord Insertion (Pci) ...mentioning

confidence: 99%

Section: Marginal Cord Insertion Odds Ratio Velamentous Cord Insertio...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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Placental cord insertion migration: Implications for ultrasound documentation and follow‐up of abnormal placental cord insertion site

Ward,

Sun,

Maresse

2024

Australas J Ultrason Med

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Introduction/PurposeIt is well‐documented in the literature that the placenta migrates during pregnancy; however, studies regarding placental cord insertion (PCI) migration are scarce. This longitudinal, prospective study aimed to determine whether PCI migration is a true phenomenon, to assess whether the PCI can change classification during pregnancy and to determine the validity of PCI site documentation including follow‐up of abnormal PCI.MethodsEighty‐three participants who had first, second and third trimester ultrasound examinations at a Western Australian private imaging practice over a 12‐month period between November 2021 and November 2022 were recruited. The measured distance of the lower margin of the placenta to the cervix, the distance of the PCI to the closest placental edge and the PCI classification were documented in each trimester. Data analysis was conducted to determine PCI migration rates during pregnancy and to test for association between PCI migration and maternal and placental factors.ResultsThe PCI migrated during pregnancy and the PCI classification has the potential to evolve. All identifiable PCIs that were normal in first trimester remained so throughout the pregnancy. The majority (67.6%) of cord insertions that were marginal in first trimester progressed to a normal insertion site by third trimester; 23.5% remained marginal and 8.8% evolved to a velamentous insertion. Three velamentous cord insertions were recorded in first trimester, none of which normalised—two remained velamentous during the pregnancy and one evolved to marginal in second trimester. Marginal cord insertions (MCIs) ≤10 mm from the placental edge in second trimester remained marginal in third trimester; MCIs that were >15 mm from the placental edge in second trimester normalised in third trimester.ConclusionsPlacental cord insertion migration is a phenomenon that occurs during pregnancy with the potential for PCI classification to evolve. Due to the association between abnormal PCI and perinatal complications, coupled with the potential for marginal cord insertion to evolve, documentation of PCI and follow‐up of abnormal PCI is beneficial, particularly in cases of velamentous insertion and marginal insertion at the placental edge or in the lower uterus.

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