From the Guidelines
The treatment plan for marginal cord insertion primarily involves close monitoring throughout pregnancy rather than specific interventions, with regular ultrasound surveillance recommended to assess fetal growth, amniotic fluid levels, and placental function 1. The goal of this monitoring is to identify any potential complications early on, such as intrauterine growth restriction or preterm birth, and to take appropriate action to mitigate these risks.
- Regular ultrasounds are typically performed every 4 weeks starting at 16 weeks gestation, with more frequent monitoring if complications arise, as suggested by the most recent guidelines 1.
- Doppler studies may be used to evaluate blood flow in the umbilical cord, providing valuable information about placental function and fetal well-being.
- No specific medications are indicated solely for marginal cord insertion, but close monitoring and timely intervention can help to minimize the risks associated with this condition. The prognosis for marginal cord insertion is generally favorable, with most pregnancies having normal outcomes, but there is a slightly increased risk of adverse outcomes, including small for gestational age and sFGR, lower gestational age at birth, and intrauterine fetal demise 1.
- Continuous fetal monitoring during labor is recommended to quickly identify any potential issues and to ensure the best possible outcome for the fetus.
- Delivery can typically proceed vaginally unless other complications develop, and the increased surveillance is justified because marginal cord insertion represents a suboptimal attachment of the umbilical cord to the placenta, which can potentially compromise blood flow to the fetus if the attachment becomes further compromised during pregnancy or labor 1.
From the Research
Definition and Diagnosis of Marginal Cord Insertion
- Marginal cord insertion is a condition where the umbilical cord inserts into the placenta at the edge, rather than centrally 2, 3.
- The diagnosis of marginal cord insertion can be made using prenatal ultrasonography, which can visualize the location of the cord insertion into the placenta 3.
- A study found that the sonographic assessment of cord insertion correlated with the pathologic outcome in 83% of singleton pregnancies and at least one of the fetuses in 72% of twin or triplet pregnancies 3.
Treatment Plans for Marginal Cord Insertion
- There is no specific treatment plan for marginal cord insertion, but close monitoring of the pregnancy is recommended to detect any potential complications 4, 5.
- Elective caesarean delivery may be considered in some cases, especially if there are other complications present 4.
- A study found that marginal cord insertion in the first trimester has the potential to progress to furcate cord insertion, which can increase the risk of perinatal complications 4.
Prognosis for Marginal Cord Insertion
- The prognosis for marginal cord insertion is generally good, but there is an increased risk of perinatal complications, such as fetal growth restriction, oligohydramnios, and placental abruption 2, 5.
- A study found that marginal cord insertion was associated with a higher incidence of small for gestational age (SGA) infants, abnormal placental morphology, and cord-related adverse pregnancy outcomes 4.
- Another study found that the prevalence of marginal cord insertion was 5.71% among singleton pregnancies, and that assisted reproductive technology, chronic hypertension, placenta previa, and nulliparity were significant risk factors for marginal cord insertion 5.
Risk Factors for Marginal Cord Insertion
- The risk factors for marginal cord insertion include assisted reproductive technology, chronic hypertension, placenta previa, and nulliparity 5.
- A study found that there was no significant association between marginal cord insertion and smoking, maternal age, prior Cesarean section, preexisting diabetes, or Caucasian ethnicity 5.
- Another study found that velamentous cord insertion, which is a more severe form of marginal cord insertion, was associated with an increased incidence of structural defects, particularly those due to deformation of a normally formed part 6.