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Perinatal Outcomes Based on Placental Cord Insertion Site
Katherine Pressman1, Lilla Markel1, Anthony Odibo2
1Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida.
American Journal of Perinatology
|May 5, 2025
Summary
Velamentous cord insertion (VCI) is linked to earlier delivery and increased hypoglycemia risk in newborns. This study highlights VCI as a significant factor in adverse perinatal outcomes, necessitating further research.
Area of Science:
- Perinatal Medicine
- Obstetrics
- Neonatology
Background:
- Societal guidelines for managing placental cord insertion (PCI) variations lack consistency.
- Inconsistent risk reporting for marginal and velamentous cord insertion (VCI) contributes to management discrepancies.
- Understanding PCI variations is crucial for pregnancies at risk for fetal growth disorders.
Purpose of the Study:
- To compare perinatal outcomes based on placental cord insertion (PCI) site.
- To investigate the association between VCI and specific adverse perinatal outcomes.
- To analyze PCI variations in singleton pregnancies undergoing fetal growth assessment.
Main Methods:
- Secondary analysis of singleton pregnancies with growth assessment (26-36 weeks gestation).
- Exclusion of fetuses with chromosomal or congenital malformations.
- Primary outcomes: neonatal small for gestational age (SGA), birthweight, gestational age at delivery; secondary outcomes included adverse neonatal and obstetrical composites, and hypoglycemia. Statistical analyses included chi-squared, Kruskal-Wallis, and logistic regression.
Main Results:
- Of 660 fetuses with confirmed PCI, 92% had central, 5.6% marginal, and 2.1% velamentous cord insertion (VCI).
- VCI was associated with significantly lower gestational age at delivery (37.6 vs. 38.6 weeks) compared to central PCI (p=0.032).
- Neonatal hypoglycemia rates were significantly higher in VCI (71.4%) versus central (26.2%) and marginal (20%) PCI groups (p<0.001), remaining significant after confounder adjustment (aOR=5.52).
Conclusions:
- Velamentous cord insertion (VCI) is associated with earlier gestational age at delivery and increased rates of neonatal hypoglycemia.
- The findings underscore the clinical significance of VCI in perinatal outcomes.
- Further research is warranted to fully elucidate the risks associated with marginal cord insertion and VCI.
