First trimester ultrasound prediction of velamentous cord insertions: a prospective study

Abstract

Introduction

The marginal and velamentous cord insertions complicate around 8% of pregnancies and are at higher risk of adverse perinatal outcomes. Their visualisation seems to decrease with advancing gestational age. Our aim was to analyse whether an umbilical cord insertion in the lower third of the uterus during the first trimester could predict abnormal cord insertions later in pregnancy.

Methods

This was a prospective multicentre study in two hospitals. During the first trimester, the cord insertions were inspected as well as their location (lower third of the uterus or not). Finally, all cord insertions were described at delivery.

Results

During the study period the cord insertion was described in 1620 patients of which 87.7% had a normal cord insertion, 11.9% (n = 192) a low cord insertion, and in 3.8% the insertion could not be situated. We find that 4.7% of those who have a low-lying cord insertion versus 0.7% in the normal cord insertion group during the first trimester will have a velamentous cord insertion subsequently (OR = 6.67; 95% CI = 2.67–16.63).

Conclusion

The detection of a low lying umbilical cord insertion during the first-trimester ultrasound can help to predict an abnormal cord insertion at delivery particularly a velamentous cord insertion.

Keywords:

• Cord insertion
• first trimester
• ultrasound
• vasa previa
• velamentous cord insertion

Ethical approvement

The study protocol was approved by the local ethics committee.

Authors contribution

Sara Derisbourg: I declare that I am the principal investigator, I participated in the conception and design of the study protocol, in the implementation in the two hospitals, in the collection, analysis and interpretation of data and I drafted the work.

Amélie Boulay has participated in the investigation (coinvestigator), in the collection of data and substantively revised the work. Clotilde Lamy has participated in the implementation of the study in Ixelles hospital, in the acquisition of data and substantively revised the work. Patricia Barlow has participated in the implementation of the study in Saint Pierre hospital and substantively revised the work. Michel Van Rysselberge has participated in the implementation of the study in Saint Pierre hospital, in the acquisition of data and substantively revised the work. Serge Rozenberg has participated in the analysis and interpretation of data, in the proofreading and substantively revised the work. Dominique Thomas has participated in the conception and design of the study protocol, in the implementation in Ixelles hospital, in the acquisition of data and substantively revised the work. Caroline Daelemans has participated in the acquisition of data, in the draft of the work and substantively revised the work.

All the authors have approved the submitted version and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work.

Disclosure statement

None of the authors declare a conflict of interest for this study.

Data availability statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

“Bourse Iris Recherche” which was used to pay the principal investigator part-time.