Marginal cord insertion

Last revised by Satish Kumar Gupta on 29 Sep 2023

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.

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.

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