Peripheral cord insertion is associated with adverse pregnancy outcome only when accompanied by clinically significant placental pathology.
Peripheral cord insertion is associated with adverse pregnancy outcome only when accompanied by clinically significant placental pathology.
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仅当伴有临床上显着的胎盘病理时，外周脐带插入才与不良妊娠结局相关。
DOI：
10.1002/uog.26206
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Cahill,LS
中科院分区：
文献类型：
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作者：
Stapleton,D;Darmonkow,A;RaviChandran,A;Milligan,N;Saghian,R;Shinar,S;Whitehead,CL;Hobson,SR;Serghides,L;Macgowan,CK;Sled,JG;Kingdom,JC;Baschat,AA;Parks,WT;Cahill,LS
目的探讨脐带插入部位，胎盘病理和不良妊娠结局之间的关系，在一个队列的正常和复杂的pregnances.MethodsSonographic测量脐带插入和详细的胎盘病理进行了309名参与者。脐带插入部位，胎盘病理学和不良妊娠结局（先兆子痫，早产，小于胎龄）之间的关联进行了检查。ResultsA共93（30%）的参与者被确定的病理检查有外周脐带插入部位。产前超声仅检出41/93条（44%）外周脐带。外周插入脐带与诊断性胎盘病理学（最常见的是母体血管灌注不良（MVM））显著相关（P< 0.0001）;其中85%的妊娠结局不良。在无胎盘病理的孤立性外周脐带病例中，不良结局的发生率与中央脐带插入且无胎盘病理的病例相比无统计学差异（31%vs18%;P= 0.3）。脐带异常脐动脉（UA）搏动指数（PI）对应于不良结局的情况下，96%的29%相比，当UA-PI是norm.ConclusionsThis研究表明，外周脐带插入往往是频谱的一部分，MVM疾病的发现，并与不良妊娠结局。然而，当有孤立的外周脐带插入和无胎盘病理时，不良结局是罕见的。因此，当观察到周围脊髓时，应寻求MVM的其他超声和生化特征。© 2023 International Society of Ultrasound in Obstetrics and Gynecology.
ObjectiveTo examine the relationship between umbilical cord insertion site, placental pathology and adverse pregnancy outcome in a cohort of normal and complicated pregnancies.MethodsSonographic measurement of the cord insertion and detailed placental pathology were performed in 309 participants. Associations between cord insertion site, placental pathology and adverse pregnancy outcome (pre‐eclampsia, preterm birth, small‐for‐gestational age) were examined.ResultsA total of 93 (30%) participants were identified by pathological examination to have a peripheral cord insertion site. Only 41 of the 93 (44%) peripheral cords were detected by prenatal ultrasound. Peripherally inserted cords were associated significantly (P< 0.0001) with diagnostic placental pathology (most commonly with maternal vascular malperfusion (MVM)); of which 85% had an adverse pregnancy outcome. In cases of isolated peripheral cords, without placental pathology, the incidence of adverse outcome was not statistically different when compared to those with central cord insertion and no placental pathology (31%vs18%;P= 0.3). A peripheral cord with an abnormal umbilical artery (UA) pulsatility index (PI) corresponded to an adverse outcome in 96% of cases compared to 29% when the UA‐PI was normal.ConclusionsThis study demonstrates that peripheral cord insertion is often part of the spectrum of findings of MVM disease and is associated with adverse pregnancy outcome. However, adverse outcome was uncommon when there was an isolated peripheral cord insertion and no placental pathology. Therefore, additional sonographic and biochemical features of MVM should be sought when a peripheral cord is observed. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.