Marginal cord insertion
Citation, DOI & article data
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). Whereas 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 very important to locate the umbilical cord in all patients, particularly in high-risk pregnancy.
- intrauterine growth restriction (IUGR) / low birth weight
- monochorionic twins pregnancy
- placental abruption 10
- pre-eclampsia 10
- nuchal cord entanglement 10
- preterm birth 7
Some authors state that there is no increased risk 5.
Treatment and prognosis
Progression into a velamentous cord insertion as a result of "placental trophotropism" can be seen in later stages of pregnancy. Second-trimester marginal cord insertion can be associated with increased likelihood for 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. 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