First trimester ultrasound prediction of velamentous cord insertions: a prospective study.

Introduction: The marginal and velamentous cord insertions complicate around 8% of pregnancies and are at higher risk of adverse perinatal outcomes. Their visualisation seems to decrease with advancing gestational age. Our aim was to analyse whether an umbilical cord insertion in the lower third of the uterus during the first trimester could predict abnormal cord insertions later in pregnancy.

Methods: This was a prospective multicentre study in two hospitals. During the first trimester, the cord insertions were inspected as well as their location (lower third of the uterus or not). Finally, all cord insertions were described at delivery.

Results: During the study period the cord insertion was described in 1620 patients of which 87.7% had a normal cord insertion, 11.9% ( = 192) a low cord insertion, and in 3.8% the insertion could not be situated. We find that 4.7% of those who have a low-lying cord insertion versus 0.7% in the normal cord insertion group during the first trimester will have a velamentous cord insertion subsequently (OR = 6.67; 95% CI = 2.67-16.63).

Conclusion: The detection of a low lying umbilical cord insertion during the first-trimester ultrasound can help to predict an abnormal cord insertion at delivery particularly a velamentous cord insertion.