Abnormal Placental Cord Insertion Research Articles

Diagnosis of arcuate uterus using three-dimensional transvaginal ultrasound and investigation of its association withperinatal complications.

Arcuate uterus does not impact the success of infertility treatments, but there is no consensus on whether it influences perinatal outcomes. The objective of the present study was to investigate whether minor congenital uterine anomalies such as an arcuate uterus contribute to perinatal complications. This was a retrospective cohort study at a single institution. The study included 1097 deliveries after 22 weeks of gestation. Transvaginal ultrasound, with three-dimensional functionality, assessed uterine morphology based on American Society for Reproductive Medicine criteria. We compared maternal backgrounds and perinatal complications between arcuate uterus and normal uterus groups. Statistical analyses, including multivariate analysis, aimed to identify independent risk factors. A total of 69 patients (7.5%) with diagnosed arcuate uterus were included. Maternal background factors showed no significant differences between groups. In perinatal complications, an arcuate uterus was associated with a significantly higher incidence of preterm delivery (13% versus 4.7%, P = 0.01), preterm premature rupture of membranes (7.2% versus 1.6%, P = 0.01), fetal growth restriction (FGR; 16% versus 6.7%, P = 0.01), and abnormal placental cord insertion (33% versus 7.6%, P < 0.01). After multivariate analysis, arcuate uterus emerged as an independent risk factor for preterm delivery (adjusted odds ratio [aOR], 4.0 [95% confidence interval (CI), 1.6-9.9], P < 0.01), FGR (aOR, 2.6 [95% CI, 1.2-5.6], P = 0.02), and abnormal placental cord insertion (aOR, 6.0 [95% CI, 3.4-10.6], P < 0.01). Arcuate uterus stands as an independent risk factor for preterm delivery, FGR, and abnormal placental cord insertion. The findings emphasize the importance of recognizing even minor uterine morphological abnormalities in assessing and managing perinatal complications.

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

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

Association of congenital uterine anomaly with abnormal placental cord insertion and adverse pregnancy complications: a retrospective cohort study

Objective Congenital uterine anomalies during pregnancy increase the risk of pregnancy complications such as miscarriage, preterm delivery, fetal malpresentation, cesarean delivery, and fetal growth restriction. However, few studies have examined uterine anomalies in relation to perinatal complications other than those mentioned above. We investigated the association between pregnancies complicated by congenital uterine anomalies and various perinatal outcomes at our institution. Methods This retrospective cohort study was conducted from January 2009 to May 2021. We included cases of uterine anomalies, such as septate, bicornuate, unicornuate, and didelphic uterus. First, the perinatal complications and neonatal outcomes were compared between pregnancies complicated by uterine anomalies and those with normal uteri. Second, we conducted an analysis based on the type of uterine anomalies classified into two groups: the minor anomaly group consisted of anomalies limited to the uterine cavity, such as the septate uterus, whereas the major anomaly group included anomalies affecting the uterine shape, such as bicornuate, unicornuate, and didelphic uterus. We compared the incidence of perinatal complications among the major anomaly, minor anomaly, and normal uterus groups. Results During the study period, 45 pregnancies were complicated with uterine anomalies. The minor anomaly group included 11 patients and the major anomaly group included 34 patients. The incidence of fetal malpresentation was significantly higher in the uterine anomaly group than in the normal uterus group (18% vs. 3.7%, p = .04). Furthermore, the frequency of abnormal placental cord insertion was significantly higher in the uterine anomaly group (16% vs. 3.7%, p = .01). Examination based on the type of uterine anomaly revealed significant differences in cervical incompetence, malpresentation, cesarean section, and abnormal placental cord insertion. Cervical incompetence was more likely in patients with minor anomalies. In contrast, fetal malpresentation, cesarean section, and abnormal placental cord insertion were more likely in the major anomaly group. Conclusions In addition to the findings reported in previous studies, abnormal placental cord insertion was more frequent in pregnancies complicated by uterine anomalies.

Risk factors analysis and multidisciplinary team first-aid simulation training for umbilical cord prolapse can improve neonatal outcomes

Objective In the present study, we sought to identify risk factors for umbilical cord prolapse (UCP) and adapt the multidisciplinary team (MDT) first-aid simulation training for UCP patients. We evaluated the usefulness of the MDT first-aid simulation by comparing delivery outcomes for UCP patients before and after its implementation. Material and methods A retrospective review was conducted on 149 UCP cases (48 overt and 101 occult) and 298 control deliveries that occurred at the Third Affiliated Hospital of Sun Yat-sen University from January 1998 to December 2022. Patient data were compared between the groups. One-way analysis of variance (ANOVA) was used for means comparison, and the chi-square test was used for categorical data. Univariate and multivariate logistic regression analyses were performed to identify factors significantly associated with UCP. Results Overt UCP was strongly associated with all adverse delivery outcomes. Both univariate and multivariate analyses identified multiparity, breech presentation, polyhydramnios, and low birth weight as independent risk factors for overt UCP (all odds ratios [OR] > 1; all p < 0.05). Preterm labor and abnormal placental cord insertion were identified as independent risk factors for occult UCP (all OR > 1; all p < 0.05). After 2014, when obstetrical staff received MDT first-aid simulation training, patients with overt UCP experienced shorter decision-to-delivery intervals due to more timely cesarean sections. They also had higher Apgar scores at 1, 5, and 10 min, and lower admission rates to the neonatal intensive care unit compared to patients before 2014 (all p < 0.05). Conclusion MDT first-aid simulation training for overt UCP can improve neonatal outcomes. However, medical simulation training efforts should initially focus on the early identification of risk factors for both overt and occult UCP.

Outcome of monochorionic diamniotic twin pregnancy with selective intrauterine growth restriction, a single center study in China

IntroductionThis retrospective study aimed to evaluate clinical outcomes of monochorionic diamniotic (MCDA) twins with selective intrauterine growth restriction (sIUGR). Materials and methodsMCDA twins, either sIUGR and non-sIUGR, underwent expectant management from 2016 to 2019 in our hospital were included. sIUGR fetuses were classified into three types according to umbilical artery Doppler assessment. Non-sIUGR were considered as the control group. Outcomes were pregnancy outcomes and maternal complications. ResultsForty-three sIUGR (type I: 23; type II: 14, and type III: 6) and 282 non-sIUGR fetuses were included. The sIUGR group had a significantly earlier birth, lower birth weight of the twins, larger inter-twin weight difference, lower Apgar score of the twins, and higher intrauterine fetal death (IUFD) than the non-sIUGR group (all p < 0.001). The same trend was found in the sIUGR type II group compared to type I and III groups. A significantly lower gestational diabetes rate (p = 0.01) and placenta weight (p < 0.001), and higher proportions of abnormal placental umbilical cord insertion (p < 0.001), and ultrasound Doppler monitoring indicators (p = 0.006) were found in the sIUGR group than the non-sIUGR group. ConclusionsThe MCDA twins with sIUGR showed poorer outcomes than the non-sIUGR group. Doppler interrogation was a useful clinical marker for fetal outcome.

EP17.03: Impact of abnormal placental cord insertion on hemodynamic change of umbilical cord

EP17.03: Impact of abnormal placental cord insertion on hemodynamic change of umbilical cord

EP16.11: Abnormal placental cord insertion increases in the lateral placenta of older pregnant women

EP16.11: Abnormal placental cord insertion increases in the lateral placenta of older pregnant women

Current practice of placental cord insertion documentation in Australia - A sonographer survey.

During 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. Members of the Australian Sonographer Accreditation Registry were invited to participate in an online survey which was distributed between February and March 2022. Four 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. Considering 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.

Twin gestation with abnormal placental cord insertion associated with poor outcome

Twin gestation with abnormal placental cord insertion associated with poor outcome

Fetal heart rate evolution patterns in cerebral palsy associated with umbilical cord complications: a nationwide study

BackgroundThe aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications.MethodsThis case–control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications.ResultsThere were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001).ConclusionHypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery.

Abnormal placental cord insertion, hypertensive disorders of pregnancy and birth length may be involved in development of hypospadias in male fetuses.

ObjectivesHypospadias is a congenital disease characterized by morphological abnormalities of the penis, including abnormal urethral opening and penile flexion, which cause urination disorders and/or sexual intercourse difficulty. Various factors have been suggested to cause this anomaly, but evidence concerning risk factors causing this anomaly is insufficient. We evaluated the etiology of hypospadias in Japan using the Common Database of the National Hospitals' Neonatal study group.Study designWe retrospectively evaluated 7,865 male neonates registered in the NICU Common Database of the National Hospitals' Neonatal study group. The subjects were divided into two groups by the presence (n = 43) or absence (n = 7,822) of hypospadias. Statistical analyses were performed to compare nominal variables between the groups by Fisher's direct establishment calculation method and logistic regression analyses.ResultsA univariate analysis showed significant between‐group differences in hypertensive disorders in pregnancy (odds ratio [OR]: 4.02, 95% confidence interval [CI]: 1.95–7.90), placental weight <−1.28 standard deviation (SD; OR: 5.06, 95% CI: 2.45–10.32), abnormal placental cord insertion (OR: 4.7, 95% CI: 2.62–9.76), birth length <−2SD (OR: 10.56, 95% CI: 5.00–21.1) and birth weight <−2SD (OR: 8.17, 95% CI: 4.17–15.68). A multivariate analysis showed a significant between‐group difference in hypertensive disorders of pregnancy (adjusted OR [AOR]: 2.30, 95% CI: 1.09–4.85), abnormal placental cord insertion (AOR: 3.69, 95% CI: 1.83–7.44) and birth length <−2SD (AOR: 3.44, 95% CI: 1.26–9.42).ConclusionAbnormal placental cord insertion, hypertensive disorders of pregnancy and birth length may be involved in hypospadias development in male neonates in conjunction with placental dysfunction in early pregnancy.

VP44.13: Prenatal ultrasound diagnosis of abnormal placental cord insertion and pregnancy outcome

Abnormal placental cord insertion includes marginal and velamentous placental cord insertion. With the development of obstetric ultrasound, such abnormal placental cord insertion can be diagnosed prenatal, and the relationship between the abnormal placental cord insertion of prenatal diagnosis and the pregnancy outcome is to be investigated. We performed a prospective study of singleton and multiple pregnancies women undergoing obstetric ultrasonography between 20–24 weeks of gestation at Ewha Women's University Hospital from February 2019 to October 2020. For the characteristics of pregnant women and pregnancy outcome, continuous variables were expressed as mean ± standard deviation and were compared using Student's t-test, or median (IQR) using Mann-Whitney test. Abnormal placental cord insertion was confirmed in 23 cases (6.42%) after a total of 358 deliveries, which 18 cases (5.02%) of marginal cord insertion were found, and 5 cases (1.40%) of velamentous placental cord insertion. Preterm birth, pre-eclampsia, fetal anomaly, postpartum hemorrhage, SGA, and LBW were significantly increased. (P-value< 0.05). Delivery by primary Caesarean section, gestational diabetes mellitus, low APGAR score was not statistically significant, but showed a tendency to increase. The results are given in table 1. Abnormal placental cord insertion is associated with poor pregnancy outcomes. Detecting abnormalities in the placenta attachment area before delivery can improve the prognosis of pregnancy. More cohort study is needed to evaluate the effects of abnormal placental cord insertion and pregnancy outcome. VP44.13: Table 1. Association of abnormal placental cord insertion with pregnancy outcome Central cord insertion (n = 335) Abnormal cord insertion (n = 23)

Obstetric Outcomes in Singleton Pregnancies with Abnormal Placental Cord Insertions.

There is wide variation in the management of pregnancies complicated by abnormal placental cord insertion (PCI), which includes velamentous cord insertion (VCI) and marginal cord insertion (MCI). We tested the hypothesis that abnormal PCI is associated with small for gestational age (SGA) infants. This is a retrospective cohort study of all pregnant patients undergoing anatomic ultrasound at a single institution from 2010 to 2017. Patients with abnormal PCI were matched in a 1:2 ratio by race, parity, gestational age at the time of ultrasound, and obesity to patients with normal PCIs. The primary outcome was SGA at delivery. Secondary outcomes were cesarean delivery, preterm delivery, cesarean delivery for nonreassuring fetal status, 5-minute Apgar score < 7, umbilical artery pH < 7.1, and neonatal intensive care unit admission. These outcomes were compared using univariate and bivariate analyses. Abnormal PCI was associated with an increased risk of SGA (relative risk [RR]: 2.43; 95% confidence interval [CI]: 1.26-4.69), increased risk of preterm delivery <37 weeks (RR: 3.60; 95% CI: 1.74-7.46), and <34 weeks (RR: 3.50; 95% CI: 1.05-11.63) compared with patients with normal PCI. There was no difference in rates of cesarean delivery, Apgar score of <7 at 5 minutes, acidemia, or neonatal intensive care unit admission between normal and abnormal PCI groups. In a stratified analysis, the association between abnormal PCI and SGA did not differ by the type of abnormal PCI (p for interaction = 0.46). Abnormal PCI is associated with an increased risk of SGA and preterm delivery. These results suggest that serial fetal growth assessments in this population may be warranted. · Abnormal PCI is associated with SGA infants and preterm birth.. · If an abnormal PCI is identified, the provider should consider serial growth ultrasounds.. · There is no difference in obstetric outcomes between VCI and MCI..

Placental Cord Insertion Distance From the Placental Margin and Its Association With Adverse Perinatal Outcomes

(Abstracted from Eur J Obstet Gynecol Reprod Biol 2020;255:51–55) Detection of an abnormal placental cord insertion (PCI)—either marginal or velamentous—can be assessed in the midtrimester. Marginal PCIs are defined as occurring at a distance of &lt;2 cm from the placental edge; velamentous PCIs occur when the placental cord inserts into the fetal membrane.

Association of Abnormal Placental Cord Insertion With Assisted Reproductive Technology [20A

INTRODUCTION: Abnormal placental cord insertion has been associated with an increase in preterm delivery, low birth weight, neonatal intensive care admissions and cesarean delivery. Assisted reproductive technology (ART) has been associated with some similar placenta-medicated pregnancy complications. We hypothesize an increase in abnormal placental cord insertion in pregnancies conceived using ART, thereby contributing to the increased association of adverse pregnancy outcomes. METHODS: We performed an IRB approved, retrospective chart review of 3728 singleton and twin placentas sent to pathology at the University of Massachusetts between January 2011-January 2016. Placental pathology reports were reviewed and evidence of abnormal placental cord insertion, either velamentous or marginal, were recorded. Chi-square test was used for categorical variables and student T-test for continuous. Logistic regression was used to control for potential confounders. P less than 0.05 was used for statistical significance. RESULTS: Of the 3728 pregnancies, 3615 were conceived via spontaneous conception, whereas 113 were conceived through ART. Women who conceived with ART were more likely to be married, of white race, older and have multiple gestations than those with spontaneous conception. ART pregnancies were over 2-fold more likely to have abnormal placental cord insertions (OR 2.1 [1.1–3.9], P=.03). After adjusting for confounding factors, statistical significance was no longer noted. CONCLUSION: Pregnancies conceived with ART were more likely to have abnormal placental cord insertion in our study. A larger sample size of women conceived using ART would be needed to fully understand the effect of ART on abnormal placental cord insertion beyond the confounding effect of multiple gestations.

Performance of ultrasound for the visualization of the placental cord insertion.

The purpose of this review was to review the literature on the performance of ultrasound for the visualization of the placental cord insertion (PCI) and for the diagnosis of abnormal placental cord insertion (APCI). APCI included both marginal cord insertion (MCI) and velamentous cord insertion (VCI) PCI. The overall rate of visualization of the PCI across all trimesters is 90.3% and for those studies routinely using color Doppler, 98.1% (P < 0.0001). Although the visualization was lower with advancing gestational age, it remained high even into the late third trimester. In all studies, where time was reported, the PCI was visualized in most cases in less than 1 min. Ultrasound performed best for the diagnosis of VCI with a sensitivity, specificity and positive predictive value of 100, 99.9 and 85.7%, respectively, with routine use of color Doppler. Ultrasound is an excellent screening test for the evaluation of PCI across all trimesters. The use of color Doppler increases the rate of visualization and should be routinely used. Ultrasound with color Doppler is also an excellent screening test for the diagnosis of VCI. However, the performance of ultrasound is reduced with the inclusion of MCI.

Antenatal Detection of Abnormal Placental Cord Insertion across Different Trimesters: A Prospective Cohort Study.

This article prospectively examines the use of ultrasound for antenatal detection of abnormal placental cord insertion (PCI) and compares the antenatal classification with delivered placental classification. This prospective cohort study examined 277 singleton pregnancies in a tertiary center. Scans were performed between 10 and 14, 18 and 22, and 32 and 34 weeks where PCI site was identified and its shortest distance to margin measured. Standardized images of delivered placentas were taken and digitally measured. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of antenatal classification compared with delivered placental classification were calculated. Abnormal PCI (distance < 2 cm from margin) was confirmed in 30/277 (11%) placentas at delivery. Note that 102/277 (37%) of PCI sites were classified as abnormal in the first trimester (T1), 43/277 (16%) in the second trimester (T2), and 28/277 (10%) in the third trimester (T3). Sensitivity (73%) and specificity (91%) were highest at T2. The PPVs were low (22% in T1, 51% in T2, and 64% in T3) and the NPVs were high (96% in T1 and 97% in both T2 and T3) for all scans. Abnormal PCI can be detected antenatally with optimal agreement with postnatal classification in T2. However, the incidence is overestimated at early scans with low PPVs.

117: Antenatal detection of abnormal placental cord insertion in each trimester: A prospective cohort study

Abnormal placental cord insertion (PCI) had been associated with adverse pregnancy outcomes such as small for gestational age and preterm labor. We aim to examine the use of ultrasound for antenatal detection of abnormal PCI in each trimester. This prospective cohort study examined 277 singleton pregnancies in a tertiary center. Scans were carried out between 10-14 weeks, 18-22 weeks and 32-34 weeks. The shortest distance of PCI site to the placental margin was identified and measured at each scan. A distance of less than 2 cm from the margin was categorized as abnormal PCI. Standardized images of delivered placentas were taken, and distance of the PCI site to the placental margin was measured digitally using ImageJ software. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the antenatal classification in each trimester with the delivered placental classification were calculated. Abnormal PCI was confirmed in 30/277 (11%) of placentas at delivery. Figure 1 compares the percentage classified as having abnormal PCI at each scan with the percentage at delivery. Both scan 1 and 2 over-estimated the incidence of abnormal PCI. Sensitivity and specificity were highest at scan 2 (73% and 91% respectively, see Table 1) but almost half of those identified as having abnormal PCI at scan 2 had normal PCI at delivery. It is feasible to detect abnormal PCI on ultrasound in each trimester of pregnancy, with the optimal agreement with PCI at delivery in the second trimester. However, the incidence of abnormal PCI is over-estimated at earlier scans and PPVs are low, thus we were unable to recommend the use of ultrasound to identify abnormal PCI during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1053: Accuracy of mid-trimester ultrasound (u/s) in the prediction of placental cord insertion

Abnormalities of placental cord insertion (PCI) at term has been associated with adverse obstetrical outcomes. If abnormal PCI could be reliably identified antenatally, enhanced fetal and obstetrical surveillance could potentially mitigate these associated risks. Although high resolution ultrasound (U/S) has proven useful in identifying PCI abnormalities in select obstetrical populations, the extent to which routine mid-trimester U/S screening can identify and accurately predict abnormalities of PCI at delivery is unknown. This study evaluated the feasibility of mid-trimester U/S PCI localization to correctly predict PCI at delivery. Prospective observational trial including patients with singleton gestation between 18-22 weeks presenting for fetal anatomical screening U/S at a single institution between 1/1/2013- 12/31/2013. PCI was assessed using gray scale and color doppler and categorized as central/eccentric, marginal (<2 cm was placental edge) or velamentous. The study group was comprised of those patients who delivered at the study site, in whom placenta was examined and PCI similarly categorized following delivery. The accuracy of mid-trimester U/S to predict PCI at delivery was determined by comparing antenatal prediction with actual PCI after delivery. The screening efficacy of mid-trimester U/S to predict abnormal PCI (marginal or velamentous) at term was determined. PCI was localized and documented in 919/942 (97.5%) at time of the mid-trimester screening ultrasound, PCI(U).The study group included 596 (64.9%) patients who delivered at the study site, in whom PCI was documented after delivery, PCI(D). Abnormal PCI was identified in 23/596 (3.9%) of placentas after delivery- 5 (0.8%) velamentous and 18 (3.0%) marginal insertions. The sensitivity, specificity, negative predictive value, positive predictive value of mid-trimester U/S in predicting abnormal PCI at delivery was 21.7%, 96.0%, 96.8%, and 17.9%, respectively. Although readily imaged at time of mid-trimester U/S, the ability to accurately predict abnormal PCI at delivery is poor. Any proposed antenatal management strategy for PCI abnormalities diagnosed by U/S requires consideration of the prenatal diagnostic limitations.

388: The relationship between short inter-pregnancy interval and abnormal placental cord insertion

388: The relationship between short inter-pregnancy interval and abnormal placental cord insertion