Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China.
Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children, Chongqing, 401147, China.
BMC Pregnancy Childbirth. 2023 Sep 8;23(1):648. doi: 10.1186/s12884-023-05963-1.
Velamentous cord insertion (VCI) and marginal cord insertion (MCI) are well-known risk factors for adverse perinatal outcomes in singleton pregnancies. However, the potential links between VCI or MCI and perinatal outcomes in twin pregnancies have yet to be systematically evaluated. This study aimed to investigate the relationships between VCI or MCI and perinatal outcomes in twin pregnancies.
This retrospective single-center cohort study included women with twin pregnancies who gave birth in a tertiary hospital in Southwest, China between January 2017 and December 2022. VCI and MCI were identified by abdominal ultrasound and confirmed after placental delivery. Logistic regression, multinomial logit regression and generalized estimation equation models were used to evaluate the association between VCI or MCI and perinatal outcomes.
A total of 3682 twin pregnancies were included, including 100 (2.7%) pregnancies with VCI and 149 (4.0%) pregnancies with MCI. Compared to pregnancies with normal cord insertion, both monochorionic and dichorionic pregnancies with VCI were associated with an increased risk of preterm delivery 32-34 weeks (aRRR 2.94, 95% CI 1.03-8.39; aRRR 2.55, 95% CI 1.19-5.46, respectively), while pregnancies with MCI were not associated with preterm delivery. VCI was associated with a higher incidence of placental previa (aOR 6.36, 95% CI 1.92-21.04) in monochorionic pregnancies and placental accreta (aOR 1.85, 95% CI 1.06-3.23) in dichorionic pregnancies. MCI was associated with an increased risk of preeclampsia (aOR 3.07, 95% CI 1.49-6.32), intertwin birthweight discordance ≥ 20% (aOR 2.40, 95% CI 1.08-5.60) and selective fetal growth restriction (aOR 2.46, 95% CI 1.08-5.60) in monochorionic pregnancies and small-for-gestational age neonates (aOR 1.97, 95% CI 1.24-3.14) in dichorionic pregnancies.
VCI was associated with an increased risk of preterm delivery in twin pregnancies irrespective of chorionicity, whereas MCI was associated with an increased preeclampsia risk, significant intertwin birthweight discordance in monochorionic pregnancies and small-for-gestational age neonates in dichorionic pregnancies.
帆状胎盘插入（VCI）和边缘性胎盘插入（MCI）是单胎妊娠不良围产结局的已知危险因素。然而，VCI 或 MCI 与双胎妊娠围产结局之间的潜在联系尚未得到系统评估。本研究旨在探讨 VCI 或 MCI 与双胎妊娠围产结局的关系。
这是一项回顾性单中心队列研究，纳入了 2017 年 1 月至 2022 年 12 月在中国西南地区一家三级医院分娩的双胎妊娠妇女。VCI 和 MCI 通过腹部超声检查确定，并在胎盘娩出后确认。采用 logistic 回归、多项 logit 回归和广义估计方程模型评估 VCI 或 MCI 与围产结局的关系。
共纳入 3682 例双胎妊娠，其中 100 例（2.7%）妊娠为 VCI，149 例（4.0%）妊娠为 MCI。与正常脐带插入相比，VCI 无论是在单绒毛膜性还是双绒毛膜性双胎妊娠中，均与早产 32-34 周的风险增加相关（aRRR 2.94，95%CI 1.03-8.39；aRRR 2.55，95%CI 1.19-5.46），而 MCI 与早产无关。VCI 与单绒毛膜性双胎妊娠的前置胎盘（aOR 6.36，95%CI 1.92-21.04）和胎盘植入（aOR 1.85，95%CI 1.06-3.23）的发生率较高有关。MCI 与单绒毛膜性双胎妊娠的子痫前期（aOR 3.07，95%CI 1.49-6.32）、双绒毛膜性双胎妊娠的双胎间出生体重差异≥20%（aOR 2.40，95%CI 1.08-5.60）和选择性胎儿生长受限（aOR 2.46，95%CI 1.08-5.60）的风险增加有关，与双绒毛膜性双胎妊娠的小于胎龄儿（aOR 1.97，95%CI 1.24-3.14）的风险增加有关。
VCI 与双胎妊娠的早产风险增加有关，而与绒毛膜性无关，而 MCI 与子痫前期风险增加、单绒毛膜性双胎妊娠的双胎间出生体重差异显著以及双绒毛膜性双胎妊娠的小于胎龄儿有关。
