EP16.44: Association of placental umbilical cord insertion site with maternal and perinatal outcomes

Adequate growth of the fetus depends upon the normal development and insertion of the umbilical cord. Central/paracentral placental cord insertion is considered normal while marginal/velamentous cord insertion is considered abnormal. In this study, we determined different placental umbilical cord insertion sites by ultrasound and categorised them as normal and abnormal, identified the risk factors, evaluated the outcome of pregnancies. The rationale was to identify pregnancies that require frequent surveillance for an optimal perinatal outcome. It was a prospective cohort study conducted in a tertiary care hospital for 18 months. 345 pregnant women who attended the antenatal outpatient department between 18- 22 weeks for targeted imaging of fetal anomalies (TIFFA) scan were included in the study. Ultrasound (USG) documentation of the cord insertion site on the placenta was done and women were followed up throughout pregnancy to look for development of antepartum, intrapartum and neonatal complications. Newborns were evaluated for adverse outcomes. Placental cord insertion was accurately determined at the TIFFA scan with 100% sensitivity and specificity. The study showed 44 abnormal placental cord insertions (ACI) - 42 had marginal and 2 had velamentous cord insertions. There was a high incidence of ACI noted in women aged more than 28 years, with body mass index (BMI) of more than 26.38, multiparity, previous history of myomectomy, first trimester miscarriage, and conceived by ART. Women with ACI had an increased risk of fetal growth restriction, antepartum hemorrhage and had an average baby weight of 2.7kg which was 200g less than babies with normal cord insertion. They also had lower mean APGAR score at 5 mins and required resuscitation and NICU admission. Our study concluded that it should be a good practice to document the placental CI during the TIFFA scan so that we can identify the subset of pregnant women who are prone to develop complications, thereby providing adequate surveillance for an optimal perinatal outcome.