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Placental cord insertion visualization with prenatal ultrasonography
D H Pretorius1, C Chau, D M Poeltler
1Sharp Perinatal Center, Mary Birch Hospital for Women, San Diego, California, USA.
Summary
Prenatal ultrasound effectively identifies placental cord insertion sites, correlating with pathology in most cases. Marginal cord insertions may evolve into velamentous ones, aiding in obstetrical management planning.
Area of Science:
- Obstetrics and Gynecology
- Medical Imaging
- Fetal Medicine
Background:
- Prenatal diagnosis of placental abnormalities is crucial for fetal well-being.
- Accurate identification of cord insertion site impacts pregnancy management.
- Sonography offers a non-invasive method for assessing placental and cord anatomy.
Purpose of the Study:
- To correlate sonographic identification of placental cord insertion with placental pathology.
- To evaluate the potential evolution of marginal cord insertion into velamentous cord insertion.
- To determine the frequency and factors influencing sonographic visualization of cord insertion.
Main Methods:
- Utilized color Doppler and gray scale sonography for prenatal assessment of cord insertion.
- Correlated sonographic findings with pathological examination of placentas.
- Analyzed visualization rates across different gestational ages and pregnancy types (singleton, multiple).
Main Results:
- Sonographic assessment of cord insertion correlated with pathological outcomes in 83% of singleton and 72% of multiple pregnancies.
- High specificity (95%) but low sensitivity (42%) for abnormal cord insertion detection.
- Marginal cord insertion evolved into velamentous cord insertion in two cases.
- Cord insertion was visualized in 54% of fetuses during routine clinical practice, with visualization decreasing at later gestational ages.
Conclusions:
- Ultrasonography is valuable for identifying normal, marginal, and velamentous cord insertions.
- Marginal cord insertion can evolve into velamentous type as pregnancy progresses.
- Prenatal identification of abnormal cord insertions can inform obstetrical management strategies.