Abnormal Placental Cord Insertion and Adverse Pregnancy Outcomes: Results from a Prospective Cohort Study
16 June 2017
24 June 2017
24 July 2017 (eFirst)
Objectives To prospectively measure the distance from the placental cord insertion (PCI) site to the placental margin using digital imaging and to examine the association between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies.
Study Design This prospective cohort study examined 1,005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken and digital measurement was performed using ImageJ software.
Results The rates of velamentous (insertion into the membrane) and marginal (<2 cm from placental margin) cord insertions in a total of 1,005 singleton pregnancies were 3.6% (n = 36; 95% confidence interval [CI] = 2.5–4.9%) and 6.4% (n = 64; 95% CI = 4.9–8.1%), respectively. Abnormal PCI was found to be more common among smokers compared with non-smokers (22.7 vs. 14.8%, p = 0.04). Abnormal PCI was found to be significantly associated with small for gestational age (adjusted odds ratio [OR]: 1.73; 95% CI: 1.01–2.97, p = 0.047) and low birth weight (adjusted OR: 3.87; 95% CI: 1.72–8.71, p = 0.001).
Conclusion Digital imaging analysis using ImageJ software mapped the surface of the placenta and provided objective measurement of PCI site. In this large prospective cohort, abnormal PCIs were significantly associated with an increased risk of small for gestational age and low birth weight.
Keywordsabnormal cord insertion - digital measurements - low birth weight - marginal cord insertion - objective measurements - placental cord insertion - singletons - small for gestational age - velamentous cord insertion
Digital imaging provided objective measurements of placental cord insertions with abnormal insertions significantly associated with an increased risk of SGA and low birth weight.
This article was presented at the 37th Annual Meeting of the Society for Maternal-Fetal Medicine, Las Vegas, NV (January 23–27, 2017).
- 1 Wang Y, Zhao S. Placental Blood Circulation. Vascular Biology of the Placenta. San Rafael, CA: Morgan & Claypool Life Sciences; 2010
- 2 Baergen RN. Pathology of the umbilical cord. In Manual of Pathology of the Human Placenta. 2nd ed. Springer Science & Business Media; 2011
- 3 Benirschke K, Kaufmann P, Baergen R. Pathology of the human placenta. 5th ed. Springer; 2006
- 4 Ebbing C, Kiserud T, Johnsen SL, Albrechtsen S, Rasmussen S. Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies. PLoS One 2013; 8 (07) e70380
- 5 Pretorius DH, Chau C, Poeltler DM, Mendoza A, Catanzarite VA, Hollenbach KA. Placental cord insertion visualization with prenatal ultrasonography. J Ultrasound Med 1996; 15 (08) 585-593
- 6 Moshiri M, Zaidi SF, Robinson TJ. , et al. Comprehensive imaging review of abnormalities of the umbilical cord. Radiographics 2014; 34 (01) 179-196
- 7 Liu CC, Pretorius DH, Scioscia AL, Hull AD. Sonographic prenatal diagnosis of marginal placental cord insertion: clinical importance. J Ultrasound Med 2002; 21 (06) 627-632
- 8 Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S. Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study. Eur J Obstet Gynecol Reprod Biol 2012; 165 (02) 231-234
- 9 Esakoff TF, Cheng YW, Snowden JM, Tran SH, Shaffer BL, Caughey AB. Velamentous cord insertion: is it associated with adverse perinatal outcomes?. J Matern Fetal Neonatal Med 2015; 28 (04) 409-412
- 10 Eddleman KA, Lockwood CJ, Berkowitz GS, Lapinski RH, Berkowitz RL. Clinical significance and sonographic diagnosis of velamentous umbilical cord insertion. Am J Perinatol 1992; 9 (02) 123-126
- 11 Heinonen S, Ryynänen M, Kirkinen P, Saarikoski S. Perinatal diagnostic evaluation of velamentous umbilical cord insertion: clinical, Doppler, and ultrasonic findings. Obstet Gynecol 1996; 87 (01) 112-117
- 12 Pinar H, Goldenberg RL, Koch MA. , et al. Placental findings in singleton stillbirths. Obstet Gynecol 2014; 123 (2, Pt 1): 325-336
- 13 Vahanian SA, Lavery JA, Ananth CV, Vintzileos A. Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis. Am J Obstet Gynecol 2015; 213 (4, Suppl): S78-S90
- 14 Lavery JP. The role of placental examination and its pathology in obstetric risk management. J Healthc Risk Manag 1997; 17 (03) 15-20
- 15 Hargitai B, Marton T, Cox PM. Best practice no 178. Examination of the human placenta. J Clin Pathol 2004; 57 (08) 785-792
- 16 Cox P, Evans C. Tissue pathway for histopathological examination of the placenta. London: The Royal College of Pathologists; 2011
- 17 Al-Janabi S, Huisman A, Van Diest PJ. Digital pathology: current status and future perspectives. Histopathology 2012; 61 (01) 1-9
- 18 Pathak S, Hook E, Hackett G. , et al. Cord coiling, umbilical cord insertion and placental shape in an unselected cohort delivering at term: relationship with common obstetric outcomes. Placenta 2010; 31 (11) 963-968
- 19 Wardlaw TM. Low Birthweight: Country, Regional and Global Estimates. UNICEF; 2004
- 20 GROW Documentation, 2012 ; Available at: www.gestation.net
- 21 Perinatal Statistics Report. Economic and Social Research Institute (ESRI) on behalf of the Department of Health and Health Service Executive Ireland. Available at: www.esri.ie (June 2012)
- 22 Tita AT. When is primary cesarean appropriate: maternal and obstetrical indications. Semin Perinatol 2012; 36 (05) 324-327
- 23 Simpson LL. When is primary cesarean appropriate: fetal indications. Semin Perinatol 2012; 36 (05) 328-335
- 24 Jauniaux E, Englert Y, Vanesse M, Hiden M, Wilkin P. Pathologic features of placentas from singleton pregnancies obtained by in vitro fertilization and embryo transfer. Obstet Gynecol 1990; 76 (01) 61-64
- 25 Gavriil P, Jauniaux E, Leroy F. Pathologic examination of placentas from singleton and twin pregnancies obtained after in vitro fertilization and embryo transfer. Pediatr Pathol 1993; 13 (04) 453-462
- 26 Kaplan CG. Gross pathology of the placenta: weight, shape, size, colour. J Clin Pathol 2008; 61 (12) 1285-1295
- 27 Leong FJ, Leong AS. Digital imaging in pathology: theoretical and practical considerations, and applications. Pathology 2004; 36 (03) 234-241
- 28 Mattioli KP, Sanderson M, Chauhan SP. Inadequate identification of small-for-gestational-age fetuses at an urban teaching hospital. Int J Gynaecol Obstet 2010; 109 (02) 140-143
- 29 Chauhan SP, Beydoun H, Chang E. , et al. Prenatal detection of fetal growth restriction in newborns classified as small for gestational age: correlates and risk of neonatal morbidity. Am J Perinatol 2014; 31 (03) 187-194
- 30 Fratelli N, Valcamonico A, Prefumo F, Pagani G, Guarneri T, Frusca T. Effects of antenatal recognition and follow-up on perinatal outcomes in small-for-gestational age infants delivered after 36 weeks. Acta Obstet Gynecol Scand 2013; 92 (02) 223-229
- 31 Verlijsdonk JW, Winkens B, Boers K, Scherjon S, Roumen F. Suspected versus non-suspected small-for-gestational age fetuses at term: perinatal outcomes. J Matern Fetal Neonatal Med 2012; 25 (07) 938-943