Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Second Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Ultrasound Med. 2022 Aug;41(8):2011-2018. doi: 10.1002/jum.15883. Epub 2021 Nov 17.
To assess the impact of marginal (MCI) or velamentous (VCI) cord insertion on uterine artery pulsatility index (UtA PI), preeclampsia (PE), and offspring's birthweight (BW).
A retrospective cohort study of singleton pregnancies, undergoing routine anomaly scan at 20 -23 gestational weeks, was conducted between 2016 and 2020. The effect of placental cord insertion on BW and UtA mean PI z-scores was assessed using the t test or analysis of variance and post-hoc tests; their association with PE was evaluated with the chi-square test. A multivariate logistic regression model was employed to assess the independent association of placental cord insertion and UtA PI z-score with PE, BW <10th, <5th centile, and intrauterine death (IUD), using specific confounders.
The study population included 4453 pregnancies. Conception via assisted reproductive technology (ART) was associated with increased risk of abnormal cord insertion (odds ratio [OR]: 2.237; 95% confidence interval [CI]: 1.561-3.206; P < .001). Women with MCI/VCI had higher mean UtA PI z-score than those with central/eccentric (0.29 vs 0.01; mean difference: -0.28; 95% CI: -0.399 to -0.165; P < .001). MCI/VCI were associated with higher rates of BW <10th centile (central/eccentric: 16.2% vs MCI: 21.9% vs VCI: 35.7%; P < .001) and BW <5th centile (9.8 vs 15.1 vs 23.2%, respectively; P < .001). No association was identified between MCI/VCI and PE (P = .968). Finally, VCI (aOR: 13.717; 95% CI: 1.576-119.379; P = .018) and increased BMI (aOR: 1.167; 95% CI: 1.071-1.271; P < .001) significantly correlated with IUD.
Abnormal cord insertion is more common in ART pregnancies. MCI/VCI are associated with higher mean UtA PI and lower BW centile, but not with increased risk of PE.
评估边缘性（MCI）或帆状性（VCI）脐带插入对子宫动脉搏动指数（UtA PI）、子痫前期（PE）和胎儿出生体重（BW）的影响。
这是一项回顾性队列研究，纳入了 2016 年至 2020 年间在 20-23 孕周进行常规异常扫描的单胎妊娠。使用 t 检验或方差分析和事后检验评估胎盘脐带插入对 BW 和 UtA 平均 PI z 分数的影响；采用卡方检验评估其与 PE 的关系。使用多元逻辑回归模型，使用特定混杂因素评估胎盘脐带插入和 UtA PI z 分数与 PE、BW <10th、<5th 百分位和宫内死亡（IUD）的独立关联。
研究人群包括 4453 例妊娠。辅助生殖技术（ART）受孕与异常脐带插入的风险增加相关（优势比 [OR]：2.237；95%置信区间 [CI]：1.561-3.206；P<.001）。MCI/VCI 组的平均 UtA PI z 分数高于中央/偏心组（0.29 与 0.01；平均差值：-0.28；95%CI：-0.399 至-0.165；P<.001）。MCI/VCI 与 BW <10th 百分位的发生率较高相关（中央/偏心：16.2% 与 MCI：21.9% 与 VCI：35.7%；P<.001）和 BW <5th 百分位（分别为 9.8%、15.1%和 23.2%；P<.001）。MCI/VCI 与 PE 之间无相关性（P=0.968）。最后，VCI（比值比 [OR]：13.717；95%CI：1.576-119.379；P=0.018）和 BMI 增加（OR：1.167；95%CI：1.071-1.271；P<.001）与 IUD 显著相关。
ART 妊娠中异常脐带插入更为常见。MCI/VCI 与较高的平均 UtA PI 和较低的 BW 百分位相关，但与 PE 风险增加无关。
