Asoglu Mehmet R, Crimmins Sarah, Kopelman Jerome N, Turan Ozhan M, Goetzinger Katherine R
Department of Obstetrics, Gynecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
J Matern Fetal Neonatal Med. 2022 May;35(9):1629-1635. doi: 10.1080/14767058.2020.1763297. Epub 2020 May 13.
The objectives of this study were (1) to estimate the association between marginal placental cord insertion (PCI) and small for gestational age (SGA) and other adverse perinatal outcomes and (2) to determine if pregnancy-associated plasma protein A (PAPP-A) levels was altered in these patients.
It was a retrospective cohort study of singleton pregnancies undergoing ultrasound between 2016 and 2018. Marginal PCI was defined as a distance of ≤2 cm from placental edge to PCI site, visualized in both sagittal and transverse planes, and diagnosed between 16 and 32 weeks. Velamentous PCI were excluded. The primary outcome was SGA, defined as birthweight below 10th percentile for gestational age. Pregnancies with marginal PCI were compared to those with normal PCI with respect to maternal characteristics, PAPP-A levels and adverse perinatal and delivery outcomes.
The incidence of marginal PCI was 4.2% (76/1819). Compared to those with a normal PCI, patients with a marginal PCI were more likely to be nulliparous and less likely to be African American or morbidly obese ( < .05). SGA rate was similar between the groups (17.6% vs. 18.1%). There was a trend toward an increased incidence of oligohydramnios, polyhydramnios and breech presentation in patients with marginal PCI; however, these did not reach statistical significance. The incidence of low PAPP-A level was comparable between the groups (18.4% vs. 14.3%, > .05).
Our study did not demonstrate any increase in adverse pregnancy outcomes in the presence of marginal PCI. These findings may provide reassurance for counseling patients with this sonographic finding.
本研究的目的是（1）评估边缘性脐带胎盘插入（PCI）与小于胎龄儿（SGA）及其他不良围产期结局之间的关联，以及（2）确定这些患者的妊娠相关血浆蛋白A（PAPP-A）水平是否发生改变。
这是一项对2016年至2018年间接受超声检查的单胎妊娠进行的回顾性队列研究。边缘性PCI定义为胎盘边缘至PCI部位的距离≤2 cm，在矢状面和横切面上均可见，并在孕16至32周之间诊断。帆状PCI被排除在外。主要结局为SGA，定义为出生体重低于胎龄的第10百分位数。将边缘性PCI妊娠与正常PCI妊娠在母体特征、PAPP-A水平以及不良围产期和分娩结局方面进行比较。
边缘性PCI的发生率为4.2%（76/1819）。与正常PCI患者相比，边缘性PCI患者更可能为初产妇，而非裔美国人或病态肥胖者的可能性较小（P<0.05）。两组间SGA发生率相似（17.6%对18.1%）。边缘性PCI患者羊水过少、羊水过多和臀位的发生率有增加趋势；然而，这些均未达到统计学意义。两组间低PAPP-A水平的发生率相当（分别为18.4%和14.3%，P>0.05）。
我们的研究未显示边缘性PCI会增加不良妊娠结局。这些发现可能为对此超声检查结果的患者进行咨询提供安心依据。
