From the Research
For a 22-week pregnant woman with a two-vessel cord and marginal cord insertion, ultrasound monitoring should typically be performed every 4 weeks until delivery. After the initial diagnosis, a detailed anatomy scan should be completed to rule out associated anomalies, followed by growth scans starting at 24-28 weeks and continuing every 4 weeks thereafter. This monitoring schedule allows for timely detection of potential complications such as fetal growth restriction, which occurs more frequently with these cord abnormalities 1. The two-vessel cord results from absence of one umbilical artery and is associated with a higher risk of growth issues, while marginal cord insertion (where the cord attaches at the edge of the placenta rather than centrally) can potentially compromise blood flow to the fetus. Regular monitoring enables healthcare providers to assess fetal growth patterns, amniotic fluid levels, and placental function. If growth restriction or other concerns develop, monitoring frequency may increase to every 1-2 weeks, and additional testing such as Doppler studies might be recommended 2.
Some key points to consider in the management of this condition include:
- The presence of a single umbilical artery is associated with an increased risk of adverse perinatal outcomes, including preterm birth, perinatal and intrauterine death, and small-for-gestational-age neonates 1.
- Marginal cord insertion is also associated with an increased risk of adverse outcomes, including fetal growth restriction and preterm birth 3.
- The combination of a two-vessel cord and marginal cord insertion may increase the risk of fetal growth restriction and other complications, highlighting the importance of regular monitoring and timely intervention 4.
- Placental and cord characteristics, such as placental weight and cord length, may also be affected in pregnancies with a two-vessel cord and marginal cord insertion, and should be assessed as part of the monitoring schedule 1.
Overall, the management of a 22-week pregnant woman with a two-vessel cord and marginal cord insertion should prioritize regular ultrasound monitoring, timely detection of potential complications, and individualized care to optimize fetal outcomes.