Marginal cord insertion
Citation, DOI, disclosures and article data
At the time the article was created Yuranga Weerakkody had no recorded disclosures.View Yuranga Weerakkody's current disclosures
Marginal cord insertion, also known as a 'battledore insertion', is a type of abnormal cord insertion.
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.
The estimated incidence is at ~7% 1 of singleton pregnancies but ~25% of twin pregnancies. Hence, it is important to locate the umbilical cord in all patients, particularly high-risk pregnancies.
Some authors state that there is no increased risk 5. Perinatal outcomes are worse if the cord is attached within 1 cm of the placental edge 6.
Treatment and prognosis
Progression into a velamentous cord insertion due to "placental trophotropism" can be seen in the later stages of pregnancy. 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.
- 1. Dudiak CM, Salomon CG, Posniak HV et-al. Sonography of the umbilical cord. Radiographics. 1995;15 (5): 1035-50. Radiographics (abstract) - Pubmed citation
- 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. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon
- 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 CC, Pretorius DH, Scioscia AL et-al. Sonographic prenatal diagnosis of marginal placental cord insertion: clinical importance. J Ultrasound Med. 2002;21 (6): 627-32. J Ultrasound Med (full text) - Pubmed citation
- 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 of Ultrasound Medicine. 2019;39(2):351-8. doi:10.1002/jum.15113 - Pubmed
- 6. Doubilet PM, Benson CB. Atlas of ultrasound in obstetrics and gynecology. Lippincott Williams & Wilkins. ISBN:0781736331. Read it at Google Books - Find it at Amazon
- 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 SL, Albrechtsen S, Rasmussen S. Third stage of labor risks in velamentous and marginal cord insertion: a population-based study. (2015) Acta obstetricia et gynecologica Scandinavica. 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. J Matern Fetal Neonatal Med. 2021;34(7):1133-1137. doi:10.1080/14767058.2019.1628206 Copy Citation
- 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