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

Hailu Aragie,Mohammed Oumer

doi:10.1186/s12884-021-03703-x

Abstract

BackgroundUmbilical cord may insert abnormally i.e. marginal insertion to a placenta which can cause different birth and perinatal complications. Despite the increased effort taken by different responsible bodies, the prevalence of birth and perinatal complications are still high, possibly due to anomalous cord insertion. So far, anomalous cord insertion lacks proper attention in different medical settings. Hence, the present study aims to assess the magnitude, risk factors, and adverse birth outcomes of marginal cord insertion among singleton births.MethodsAn institution-based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants. Data were collected by using a structured questionnaire and it was entered into epi-data version 3.1 then exported to SPSS version 20 for data cleansing and analysis. Bi-variable and multivariable logistic regressions were employed to identify risk factors and adverse outcomes associated with marginal cord insertions. Crude and adjusted odds ratio (P-value < 0.05) with a 95% confidence interval were calculated.ResultThe magnitude of marginal cord insertion was 6.4% (95% CI = 4.4–8.8%) in singleton pregnancies. Independent risk factors for marginal cord insertion were advanced maternal age (AOR = 2.24, 95% CI: 1.35–11.08), primiparity (AOR = 1.98, 95% CI: 1.37–8.69), maternal chronic hypertension (AOR = 3.07, 95% CI: 1.66–9.76), previous cesarean delivery (AOR = 2.51, 95% CI: 1.43–10.21), and use of intrauterine contraceptive device before pregnancy (AOR = 2.22, 95% CI: 1.36–12.30). Pregnancies complicated by marginal cord insertion are at higher risk to develop low birth weight (AOR = 2.89, 95% CI: 1.23–6.80), preterm birth (AOR = 4.00, 95% CI: 1.44–11.14), and emergency cesarean delivery (AOR = 3.68, 95% CI: 1.03–13.81).Conclusion and recommendationMarginal cord insertion is a mistreated potential risk for low birth weight, preterm birth, and emergency cesarean delivery. Routine screening of marginal cord insertion should be considered in pregnancies with advanced age, nulliparity, hypertensive disorder, history of cesarean section, and intrauterine contraceptive device usage before pregnancy.

Highlights

The umbilical cord is a cord-like structure, which connects the fetus with the fetal surface of the placenta and it normally contains two arteries and one vein surrounded by Wharton’s jelly, all enclosed in a layer of amnion [1]
After adjusting for maternal age, parity, hypertension, current preeclampsia, and gestational diabetes mellitus (GDM) in a multivariable logistic regression, Marginal cord insertion (MCI) remained associated with low birth weight (AOR = 2.89, 95% CI = 1.23–6.80), preterm birth (AOR = 4.00, CI = 1.44–11.14) and emergency cesarean delivery (ECD) (AOR = 3.68, 95% CI = 1.03–13.81) (Table 8)
We have found that the usage of intrauterine contraceptive device (IUCD) before conception will put the mother two times higher risk of developing MCI compared to their counterparts

Summary

Introduction

The umbilical cord is a cord-like structure, which connects the fetus with the fetal surface of the placenta and it normally contains two arteries and one vein surrounded by Wharton’s jelly, all enclosed in a layer of amnion [1]. Sometimes it can attach to the periphery of the placental tissue (marginal insertion) or, otherwise the umbilical cord and its vessels inserted between the chorioamniotic membrane of the placenta rather than to the tissue [4]. Variations in the site of the insertion of the umbilical cord are thought to result from the process known as trophotrophism in which the chorionic frondosum or the early placenta migrates with advancing gestation to ensure a better blood supply from a more richly vascularized area [1]. Umbilical cord may insert abnormally i.e. marginal insertion to a placenta which can cause different birth and perinatal complications. Despite the increased effort taken by different responsible bodies, the prevalence of birth and perinatal complications are still high, possibly due to anomalous cord insertion. The present study aims to assess the magnitude, risk factors, and adverse birth outcomes of marginal cord insertion among singleton births

Objectives

Findings

Methods

Conclusion