Marginal cord insertion
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Campos A, Knipe H, et al. Marginal cord insertion. Reference article, Radiopaedia.org (Accessed on 14 Mar 2025) https://doi.org/10.53347/rID-13468
rID:
13468
Article created:
Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
Disclosures:
At the time the article was last revised Arlene Campos had no financial relationships to ineligible companies to disclose.
View Arlene Campos's current disclosures
Revisions:
21 times, by
14 contributors -
see full revision history and disclosures
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Synonyms:
- Marginal cord insertion (MCI)
- Battledore placenta
- Battledore cord insertion
- Marginal umbilical cord insertion
- Marginal insertion of umbilical cord
Marginal cord insertion, also known as a 'battledore insertion', is a type of abnormal cord insertion.
On this page:
Terminology
Insertion of the umbilical cord within <2 cm from the placental margin is described as marginal cord insertion (usually defined as <2 cm 5, although some references define it as <1 cm 3,6). In contrast, lateral insertion of the umbilical cord >2 cm from the placental margin is described as eccentric cord insertion 13.
Epidemiology
The estimated incidence is ~7.5% (range 4.2–11.3%) 1,13 of singleton pregnancies but ~25% of twin pregnancies. Hence, it is important to locate the umbilical cord in all patients, particularly high-risk pregnancies.
Pathology
Associations
intrauterine growth restriction (IUGR) / low birth weight 13
Treatment and prognosis
Progression into a velamentous cord insertion due to "placental trophotropism" can be seen in the later stages of pregnancy.
Perinatal outcomes are worse if the cord is attached within 1 cm of the placental edge 6.
Second-trimester marginal cord insertion can be associated with an increased likelihood of low birth weight, pre-term delivery and composite adverse obstetrical and neonatal outcomes 8.
References
- 1. Dudiak C, Salomon C, Posniak H, Olson M, Flisak M. Sonography of the Umbilical Cord. Radiographics. 1995;15(5):1035-50. doi:10.1148/radiographics.15.5.7501849 - Pubmed
- 2. Di salvo DN, Benson CB, Laing FC et-al. Sonographic evaluation of the placental cord insertion site. AJR Am J Roentgenol. 1998;170 (5): 1295-8. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Eberhard Merz. Ultrasound in Obstetrics and Gynecology. (2005) ISBN: 9781588901477 - Google Books
- 4. Pretorius DH, Chau C, Poeltler DM et-al. Placental cord insertion visualization with prenatal ultrasonography. J Ultrasound Med. 1996;15 (8): 585-93. J Ultrasound Med (abstract) - Pubmed citation
- 5. Liu C, Pretorius D, Scioscia A, Hull A. Sonographic Prenatal Diagnosis of Marginal Placental Cord Insertion: Clinical Importance. J Ultrasound Med. 2002;21(6):627-32. doi:10.7863/jum.2002.21.6.627 - Pubmed
- 6. Wax I, Cartin A, Craig W, Pinette M, Wax J. Second-Trimester Ultrasound-Measured Umbilical Cord Insertion-To-Placental Edge Distance: Determining an Outcome-Based Threshold for Identifying Marginal Cord Insertions. J Ultrasound Med. 2020;39(2):351-8. doi:10.1002/jum.15113 - Pubmed
- 6. Peter M. Doubilet, Carol B. Benson. Atlas of Ultrasound in Obstetrics and Gynecology. (2003) ISBN: 9780781736336 - Google Books
- 7. Ebbing C, Kiserud T, Johnsen SL et-al. Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies. PLoS ONE. 2013;8 (7): e70380. doi:10.1371/journal.pone.0070380 - Free text at pubmed - Pubmed citation
- 8. Allaf MB, Andrikopoulou M, Crnosija N, Muscat J, Chavez MR, Vintzileos AM. Second trimester marginal cord insertion is associated with adverse perinatal outcomes. (2018) The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. doi:10.1080/14767058.2018.1453798 - Pubmed
- 9. Ebbing C, Kiserud T, Johnsen S, Albrechtsen S, Rasmussen S. Third Stage of Labor Risks in Velamentous and Marginal Cord Insertion: A Population-Based Study. Acta Obstet Gynecol Scand. 2015;94(8):878-83. doi:10.1111/aogs.12666 - Pubmed
- 10. Nkwabong E, Njikam F, Kalla G. Outcome of Pregnancies with Marginal Umbilical Cord Insertion. The Journal of Maternal-Fetal & Neonatal Medicine. 2019;34(7):1133-7. doi:10.1080/14767058.2019.1628206 - Pubmed
- 11. Ismail K, Hannigan A, O'Donoghue K, Cotter A. Abnormal Placental Cord Insertion and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis. Syst Rev. 2017;6(1):242. doi:10.1186/s13643-017-0641-1 - Pubmed
- 12. Hasegawa J, Matsuoka R, Ichizuka K et al. Cord Insertion into the Lower Third of the Uterus in the First Trimester is Associated with Placental and Umbilical Cord Abnormalities. Ultrasound Obstet Gynecol. 2006;28(2):183-6. doi:10.1002/uog.2839 - Pubmed
- 13. Ward S, Sun Z, Maresse S. Current Practice of Placental Cord Insertion Documentation in Australia - A Sonographer Survey. Australas J Ultrasound Med. 2023;26(3):157-68. doi:10.1002/ajum.12360 - Pubmed
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