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Original research
Abnormal umbilical cord insertions in singleton deliveries: placental histology and neonatal outcomes
  1. Sivlia Visentin1,
  2. Ambrogio P Londero2,3,
  3. Luisa Santoro4,
  4. Sara Pizzi4,
  5. Matteo Andolfatto1,
  6. Maria Venturini1,
  7. Deborah Saraggi4,
  8. Irene Coati4,
  9. Diana Sacchi4,
  10. Massimo Rugge4,
  11. Erich Cosmi1
  1. 1 Obstetrics and Gynecology Clinic, Padua University Hospital, Padova, Italy
  2. 2 Obstetrics and Gynecology Clinic, Udine University Health Integrated Agency, Udine, Italy
  3. 3 Ennergi Research, Lestizza, Italy
  4. 4 Department of Medicine DIMED, Pathology and Cytopathology Unit, Padua University, Padova, Italy
  1. Correspondence to Dr Ambrogio P Londero, Udine University Health Integrated Agency, Udine, Friuli-Venezia Giulia, Italy; ambrogio.londero{at}gmail.com

Abstract

Aims This study aimed to identify any microscopic features associated with abnormal (membranous/velamentous or marginal) placental cord insertions and to analyse their adverse neonatal outcomes.

Methods We retrospectively analysed the records—including pathological findings, clinical information and pregnancy outcomes—for 1060 singleton pregnancies, involving newborn delivered after 24 weeks of gestation.

Results Marginal cord insertions were identified in 26.60% of cases and membranous cord insertions in 2.64%. Subchorionic vessel thrombus was more prevalent in marginal or membranous insertions (0.97%) than in normal cord insertions (0.27%) (p=0.129). Intervillous thrombi (13.73% vs 8.41%, p<0.05) and chorioamnionitis (8.53% vs 5.48%, p=0.089) were more prevalent in normal cord insertions. Premature rupture of membranes was significantly more commonly associated with abnormal (marginal 15.25% and membranous 17.86%) than with normal (9.87%) insertions (p<0.05). Pre-eclampsia was more common in the group with membranous cord insertions (7.14%) than in the other groups (marginal 0.35%; normal 0.80%) (p<0.05). Marginal and membranous placental cord insertions were associated with earlier gestational age at delivery and smaller fetuses than in the group with normal insertions. Intrauterine fetal demise, cardiac malformations and pregestational diabetes were also more common among cases of abnormal cord insertions.

Conclusions Subchorionic vessel thrombus and adverse pregnancy-related outcomes were more prevalent in cases of marginal/membranous cord insertion than for normal insertions.

  • placenta
  • pregnancy
  • infant
  • newborn
  • diseases

Data availability statement

Data are available upon reasonable request. The data supporting the findings of this study are available, but restrictions apply to their circulation as they were used under license for the present study, and are therefore not publicly available. The data may nonetheless be made available by the authors on reasonable request with the permission of the Ethics Committee.

https://doi.org/10.1136/jclinpath-2020-207342

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    Data availability statement

    Data are available upon reasonable request. The data supporting the findings of this study are available, but restrictions apply to their circulation as they were used under license for the present study, and are therefore not publicly available. The data may nonetheless be made available by the authors on reasonable request with the permission of the Ethics Committee.

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    Footnotes

    • SV and APL are joint first authors.

    • Handling editor Mona El-Bahrawy.

    • Contributors Substantial contributions to the study’s conception and design, or the acquisition, analysis and interpretation of the data (SV, APL, LS, SP, MA, MV, DeS, IC, DiS, MR, EC); drafting of the article or critical revision of its important intellectual content (SV, APL, LS, SP, MA, MV, DeS, IC, DiS, MR, EC) All authors have read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.