Impact of Marginal and Velamentous Cord Insertion on Uterine Artery Doppler Indices, Fetal Growth, and Preeclampsia. (17th November 2021)

• Record Type: Journal Article
• Authors: Tsakiridis, Ioannis; Dagklis, Themistoklis; Athanasiadis, Apostolos; Dinas, Konstantinos; Sotiriadis, Alexandros
• Is Part Of: Journal of ultrasound in medicine. Volume 41:Number 8(2022)
• Page Start: 2011
• Page End: 2018
• Publication Date: 2021-11-17
• Subjects: birthweight -- marginal -- placental cord insertion -- preeclampsia -- uterine artery -- velamentous; Ultrasonics in medicine -- Periodicals; Ultrasonics; Ultrasonography; Ultrasonics in medicine; Electronic journals; Periodicals; Periodicals; 616.07543
• DOI: 10.1002/jum.15883
• Languages: English
• ISSNs: 0278-4297

Abstract

Abstract : Objectives: To assess the impact of marginal (MCI) or velamentous (VCI) cord insertion on uterine artery pulsatility index (UtA PI), preeclampsia (PE), and offspring's birthweight (BW). Methods: A retrospective cohort study of singleton pregnancies, undergoing routine anomaly scan at 20 +0 –23 +6 gestational weeks, was conducted between 2016 and 2020. The effect of placental cord insertion on BW and UtA mean PI z ‐scores was assessed using the t test or analysis of variance and post‐hoc tests; their association with PE was evaluated with the chi‐square test. A multivariate logistic regression model was employed to assess the independent association of placental cord insertion and UtA PI z ‐score with PE, BW <10th, <5th centile, and intrauterine death (IUD), using specific confounders. Results: The study population included 4453 pregnancies. Conception via assisted reproductive technology (ART) was associated with increased risk of abnormal cord insertion (odds ratio [OR]: 2.237; 95% confidence interval [CI]: 1.561–3.206; P < .001). Women with MCI/VCI had higher mean UtA PI z ‐score than those with central/eccentric (0.29 vs 0.01; mean difference: −0.28; 95% CI: −0.399 to −0.165; P < .001). MCI/VCI were associated with higher rates of BW <10th centile (central/eccentric: 16.2% vs MCI: 21.9% vs VCI: 35.7%; P < .001) and BW <5th centile (9.8 vs 15.1 vs 23.2%, respectively; P < .001). No association was identified between MCI/VCI and PE ( P = .968). Finally, VCI (aOR: 13.717; 95% CI: 1.576–119.379; P = .018) and increased BMI (aOR: 1.167; 95% CI: 1.071–1.271; P < .001) significantly correlated with IUD. Conclusions: Abnormal cord insertion is more common in ART pregnancies. MCI/VCI are associated with higher mean UtA PI and lower BW centile, but not with increased risk of PE.