Am J Perinatol 2023; 40(01): 089-094
DOI: 10.1055/s-0041-1729163
Original Article

Obstetric Outcomes in Singleton Pregnancies with Abnormal Placental Cord Insertions

1   Division of Maternal-Fetal Medicine, Washington University in St. Louis, Missouri
Molly J. Stout
2   Division of Maternal-Fetal Medicine, University of Michigan, Ann Arbor, Michigan
Ebony B. Carter
1   Division of Maternal-Fetal Medicine, Washington University in St. Louis, Missouri
Jeffrey M. Dicke
1   Division of Maternal-Fetal Medicine, Washington University in St. Louis, Missouri
Methodius G. Tuuli
3   Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
Nandini Raghuraman
1   Division of Maternal-Fetal Medicine, Washington University in St. Louis, Missouri
› Author Affiliations
Funding N.R. is supported by the Foundation for the Society for Maternal Fetal Medicine (SMFM) and American Association of Obstetricians and Gynecologists Foundation (AAOGF).


Objective 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.

Study Design 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.

Results 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).

Conclusion 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.

Key Points

  • 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.

Publication History

Received: 07 August 2020

Accepted: 02 March 2021

Article published online:
02 May 2021

© 2021. Thieme. All rights reserved.

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