Effect of Abnormal placental cord insertion on hemodynamic change of umbilical cord in a tertiary center: A Prospective Cohort Study
Authors: Chiu Wei-Hsiu , Wu Xiu-Qin , Miao Ying , Yang Xiao-Feng , Hong Yong-Qiang , Wang Liang-Cheng 
Published: May 2023

Objectives: Our study aims to evaluate the umbilical vein
hemodynamic change in the prenatal cohort of pregnancies diagnosed with
abnormal placental cord insertion(aPCI). Methods: From January
2022 to December 2022, the fetal umbilical cord insertion site was
sonographically examined in singleton fetuses, and umbilical cord blood
flow was calculated. Evaluation of the standard placental view and views
of the umbilical cord insertion site on the placental surface by the
grayscale image with appropriate image magnification. The exact
umbilical cord insertion site was determined with two perpendicular
planes centered on the umbilical cord insertion site. All grayscale
images were followed by color Doppler flow mapping. The length of the
space between the umbilical cord insertion site and the placental margin
was less than or equal to 2 cm and was defined as abnormal placental
cord insertion(aPCI). According to ISUOG and AIUM practice guidelines,
standard fetal biometry, umbilical artery Doppler pulsatility index
(UAPI), umbilical artery resistance index (UARI), time-averaged maximum
velocity (TAMXV), and time-averaged intensity weighted mean velocity
(TAV) of the umbilical vein (UV), and placental site of umbilical
insertion was assessed, including two-dimensional grayscale imaging,
color, and Doppler color flow mapping. Main outcome measures:
Significantly lower UVBF in the VCI group, and increased relative risk
of SGA, LBW, and PTB in aPCI group. Results: Among 570
singleton fetuses between 18 and 40
weeks of gestation in the final study. The results
were divided into three subgroups according to the sonographic
assessment of the umbilical cord insertion site: 86.0% normal umbilical
cord insertions (group A), 11.6% marginal umbilical cord
insertions(MCI) (group B), and 2.5% velamentous umbilical cord
insertions (VCI) (group C). The umbilical vein blood flow (UVBF) in the
3 groups was 145.39 ml/min, 146.18 ml/min, and 93.96 ml/min,
respectively. UVBF was significantly lower in group C than in group A
and group B (p< .05). The pregnancy resulted in the birth
weight and delivered at gestational age compared with the normal cord
insertions group, with lower birth weight (2820± 527gm vs 3144± 577gm,
p < .05), and delivered at an earlier gestational age
(38.0 ± 1.55 weeks vs. 38.8 ± 2.34 weeks, p <
.05) was found in the VCI group. Conclusions: The strength of
our study is that we focused solely on the hemodynamic changes in
umbilical vein blood flow during isolated aPCI. Previous literature has
reported only prenatal outcomes of aPCI for poor prognosis; however, we
observed lower umbilical vein blood flow volume with aPCI. Hence, we
propose UVBF analysis to evaluate fetal the aPCI according to umbilical
vein hemodynamics as an advisory in prenatal care. This would be useful
and would improve the clinical explanation of obstetricians about the
potential prenatal consequences so that parents can opt for future
prenatal care during pregnancy.