Perinatal Outcomes Based on Placental Cord Insertion Site

Presently, societal guidelines differ regarding evaluation and management of variations in placental cord insertion (PCI). This variation may in part be secondary to inconsistency in reported risk associated with marginal and velamentous cord insertion (VCI). The objective of this study is to compare perinatal outcomes based on PCI site in pregnancies at risks for fetal growth disorders.This was a secondary analysis of singletons with growth assessment between 26 and 36 weeks of gestation. Fetuses with chromosomal or congenital malformations were excluded. The primary outcomes studied were neonatal small for gestational age (SGA), birth weight, and gestational age (GA) at delivery. Other outcomes included a composite of adverse neonatal outcomes, a composite score of obstetrical outcomes, and hypoglycemia. Categorical data were analyzed with χ² and continuous data with Kruskal-Wallis tests. Pairwise comparisons and Bonferroni corrections were utilized. Logistic regression model was applied to assess the association of hypoglycemia with VCI.Of the 1,054 fetuses, 660 had confirmed PCI site by pathology review. Of those, 609 (92%) had central cord insertion, 37 (5.6%) had marginal, and 14 (2.1%) had velamentous. There was no difference in SGA or preterm birth. Those with a VCI had lower GA at delivery than placentas with central cord insertion (37.6 vs. 38.6, p = 0.032) and higher rates of hypoglycemia than those with other types of PCIs, 26.2% for central cord insertion, 20% for marginal cord insertion, and 71.4% for VCI (p < 0.001). After controlling for confounders, VCI remained significantly associated with hypoglycemia (adjusted odds ratio = 5.52; 95% confidence interval: 1.54-19.82).VCI was associated with lower GA at delivery and higher rates of neonatal hypoglycemia compared with other PCIs. Additional studies are needed to assess the association of marginal cord insertion and VCI and adverse perinatal outcomes. · VCI was associated with neonatal hypoglycemia.. · VCI is associated with earlier gestational age at delivery.. · The rate of VCI is 2.1% in this cohort..