OC15.01: Prenatal determination of placental cord insertion site in monochorionic and dichorionic twin gestations: a predictor of growth discordance?
Year: 2010
Type: article
Study design: Observational Study
Abstract: To determine the utility of prenatal identification of placental cord insertion site as a possible proxy marker for subsequent development of intratwin growth discordance in monochorionic and in dichorionic twin gestations. The ESPRIT trial is a national prospective population study of 1038 consecutive twin pregnancies managed and delivered at 8 tertiary referral centers in one country. All pregnancies were followed using a uniform sonographic surveillance protocol and were delivered at one of 8 designated centers. Sonographic determination of placental cord insertion site was recorded at enrollment (11–22 weeks' gestation) and at follow-up serial evaluation. Perinatal outcomes for all participants were recorded onto a central consolidated web-based database. Placental pathology was available for correlation. Twin pregnancies were grouped according to placental cord insertion site in each twin pair (central-central; central-noncentral; and noncentral-noncentral). This study was completed by 1022 participants, and outcome data was obtained for 998 patients (98%). Eighty percent of the cohort (862) was dichorionic. On prenatal sonographic evaluation, the placental cord insertion site was recorded as central, marginal or velamentous for 73%, 16% and 3% of twin fetuses respectively. The latter 2 descriptions were considered noncentral for the purpose of this analysis. Placental cord insertion site could not be confirmed on prenatal sonographic evaluation in 8% of cases. Cord insertion site other than central correlated with monochorionic gestation (P = 0.0074). Prenatal identification of a noncentral cord insertion in either one or both fetuses of a twin pair correlated with birth weight discordance of ≥ 20% (P = 0.0115). Prenatal sonographic evidence of a marginal or velamentous cord insertion in either one or both twins correlates with subsequent intratwin birth weight discordance and may merit a strategy of heightened fetal growth surveillance in such pregnancies.
DOI: 10.1002/uog.7857
Authors: F. Breathnach, F. McAuliffe, M. Geary, S. Daly, J. Higgins, J. J. Dornan, J. J. Morrison, G. Burke, S. Higgins, S. Carroll, F. Malone
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2128369412