Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective ESPRiT Study

Kent, Etaoin; Breathnach, Fionnuala; Gillan, John; McAuliffe, Fionnuala M.; Geary, Michael; Daly, Seán; Higgins, John R.; Dornan, James; Morrison, John J.; Burke, Gerald; Higgins, Shane; Carroll, Stephen; Dicker, Patrick; Manning, Fiona; Malone, Fergal D.

doi:10.1016/j.ajog.2011.06.077

Cited by 121 publications

(76 citation statements)

References 17 publications

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“…It has been reported that velamentous cord insertion (VCI) in monochorionic twin pregnancies is more frequent than in either dichorionic twins or singletons [14,15]. Several authors reported a strong correlation between VCI and the onset of TTTS [16,17], whereas other studies were not in agreement [15,18,19].…”

Section: Introductionmentioning

confidence: 58%

“…However, these studies were compromised by a small sample size and/or incomplete data. On the other hand, several recent studies came to an opposite conclusion [15,18,19]. These studies collected data from tertiary hospitals for complicated pregnancies; thus, they might not reflect the general twin population.…”

Section: Discussionmentioning

confidence: 94%

“…Several authors reported a strong correlation between VCI and the onset of TTTS [16,17], whereas other studies were not in agreement [15,18,19]. In addition, the correlation among VCI and intrauterine fetal growth restriction and severe birth weight discordance has also been reported [20,21,22].…”

Section: Introductionmentioning

confidence: 87%

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Significance of Velamentous Cord Insertion for Twin-Twin Transfusion Syndrome

et al. 2015

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Introduction: The objective of this study was to evaluate the actual association between velamentous cord insertion (VCI) and twin-twin transfusion syndrome (TTTS) in the native cohort concerning the natural history of monochorionic twin pregnancies. Material and Methods: All monochorionic diamniotic twin pregnancies who received prenatal care from <16 weeks of gestation until delivery at our center between 2004 and 2013 were included in this retrospective cohort study. Macroscopically defined cord insertion site was recorded as velamentous, marginal, or central. The effects of VCI on TTTS and a composite of adverse outcomes, including abortion, death, and neurological morbidities ≤28 days of age, were evaluated with a multiple logistic regression model. Results: A total of 357 monochorionic diamniotic twin pregnancies were analyzed. VCI in both twins was noted in 2.5% of cases and VCI in at least one twin was noted in 22.1% of cases. The incidence of TTTS was 8.4%; the incidence of a composite of adverse outcomes in at least one twin was 9.8%. There was no correlation between VCI and TTTS as well as a composite of adverse outcomes. Discussion: VCI in monochorionic twin pregnancies was not a risk factor for TTTS and severe perinatal morbidities.

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Section: Introductionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 94%

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Significance of Velamentous Cord Insertion for Twin-Twin Transfusion Syndrome

et al. 2015

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“…Notification of any malformation was done by the attending physician at birth or at the neonatal care unit. The association between anomalous cord insertion and birthweight discordance between twins (defined as the absolute difference in birthweight between the twins expressed as a percentage of the weight of the larger twin) was determined, with a difference of >20% regarded as discordant [11].…”

Section: Methodsmentioning

confidence: 99%

“…Velamentous and marginal insertions are reported to occur in 0.5–2.4% and 8.5% of all pregnancies, respectively [2], [3], [10], with the prevalence being higher in multiple pregnancies [11] and in pregnancies conceived with the aid of assisted reproductive technology [12]. However, these prevalence rates are derived from hospital registers, which might be influenced by selection bias, and population-based studies are lacking.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies

et al. 2013

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ObjectivesTo determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.DesignPopulation-based registry study.SettingMedical Birth Registry of Norway 1999–2009.PopulationAll births (gestational age >16 weeks to <45 weeks) in Norway (623,478 singletons and 11,263 pairs of twins).MethodsDescriptive statistics and odds ratios (ORs) for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.Main outcome measuresVelamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit (NICU), malformations, birthweight, and perinatal death.ResultsThe prevalence of abnormal cord insertion was 7.8% (1.5% velamentous, 6.3% marginal) in singleton pregnancies and 16.9% (6% velamentous, 10.9% marginal) in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia (OR = 3.7, (95% CI = 3.1–4.6)), and placental abruption (OR = 2.6, (95% CI = 2.1–3.2)). The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 (95% CI = 2.5–4.3).ConclusionThe prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more common than velamentous. The conditions were associated with common risk factors and an increased risk of adverse perinatal outcomes; these risks were greater for velamentous than for marginal insertion.

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Intertwin membrane cord insertion in dichorionic twin pregnancy: The description and comparison with other umbilical cord insertion types

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Türkyilmaz

et al. 2022

J of Clinical Ultrasound

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Purpose Multiple pregnancy is associated with high perinatal mortality and morbidity. Abnormal cord insertions more common in twin pregnancies compared to singleton pregnancies and velamentous cord insertion is related with poor pregnancy outcomes. There is no definition of velamentous cord insertion into the intertwine membrane between two fetuses in the literature. Methods In our single‐center cross‐sectional study, monochorionic‐diamniotic and dichorionic‐diamniotic twins who were admitted to our clinic between 18 + 0 and 23 + 6 weeks of pregnancy were enrolled in this study. We evaluated fetal, placental, and umbilical cord abnormalities in addition to fetal growth restrictions and weight discordance by ultrasonography. Results Although abnormal cord insertion frequency was significantly higher in monochorionic twins (p = 0.003), intertwin membrane cord insertion could only occur in dichorionic twins. In cases with cord insertion anomaly; FGR and weight discordance was observed more frequently (p < 0.001 and p = 0.003, respectively). Weight discordance, the presence of abnormal cord insertion and abnormal UAD were found as statistically significant predictors of FGR (p < 0.001, p = 0.021, and p < 0.001, respectively). Conclusion Intertwin membrane insertion is a novel umbilical cord insertion abnormality. The presence of abnormal umbilical cord insertion is a risk factor for poor pregnancy outcomes in twin pregnancies.

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Placental cord insertion and birthweight discordance in twin pregnancies: results of the national prospective ESPRiT Study

Cited by 121 publications

References 17 publications

Significance of Velamentous Cord Insertion for Twin-Twin Transfusion Syndrome

Significance of Velamentous Cord Insertion for Twin-Twin Transfusion Syndrome

Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies

Intertwin membrane cord insertion in dichorionic twin pregnancy: The description and comparison with other umbilical cord insertion types

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