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Effect of Abnormal placental cord insertion on hemodynamic change of umbilical cord in a tertiary center: A Prospective Cohort Study
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  • Wei-Hsiu Chiu,
  • Xiu-Qin Wu,
  • Ying Miao,
  • Xiao-Feng Yang,
  • Yong-Qiang Hong,
  • Liang-Cheng Wang
Wei-Hsiu Chiu
Chung Shan Hospital

Corresponding Author:[email protected]

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Xiu-Qin Wu
Mindong Hospital of Ningde City
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Ying Miao
Mindong Hospital of Ningde City
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Xiao-Feng Yang
Mindong Hospital of Ningde City
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Yong-Qiang Hong
Mindong Hospital of Ningde City
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Liang-Cheng Wang
Kawaguchi Ladies Clinic
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Abstract

Objectives: Our study aims to evaluate the umbilical vein hemodynamic change in the prenatal cohort of pregnancies diagnosed with abnormal placental cord insertion(aPCI). Methods: From January 2022 to December 2022, the fetal umbilical cord insertion site was sonographically examined in singleton fetuses, and umbilical cord blood flow was calculated. Evaluation of the standard placental view and views of the umbilical cord insertion site on the placental surface by the grayscale image with appropriate image magnification. The exact umbilical cord insertion site was determined with two perpendicular planes centered on the umbilical cord insertion site. All grayscale images were followed by color Doppler flow mapping. The length of the space between the umbilical cord insertion site and the placental margin was less than or equal to 2 cm and was defined as abnormal placental cord insertion(aPCI). According to ISUOG and AIUM practice guidelines, standard fetal biometry, umbilical artery Doppler pulsatility index (UAPI), umbilical artery resistance index (UARI), time-averaged maximum velocity (TAMXV), and time-averaged intensity weighted mean velocity (TAV) of the umbilical vein (UV), and placental site of umbilical insertion was assessed, including two-dimensional grayscale imaging, color, and Doppler color flow mapping. Main outcome measures: Significantly lower UVBF in the VCI group, and increased relative risk of SGA, LBW, and PTB in aPCI group. Results: Among 570 singleton fetuses between 18 +0 and 40 +6 weeks of gestation in the final study. The results were divided into three subgroups according to the sonographic assessment of the umbilical cord insertion site: 86.0% normal umbilical cord insertions (group A), 11.6% marginal umbilical cord insertions(MCI) (group B), and 2.5% velamentous umbilical cord insertions (VCI) (group C). The umbilical vein blood flow (UVBF) in the 3 groups was 145.39 ml/min, 146.18 ml/min, and 93.96 ml/min, respectively. UVBF was significantly lower in group C than in group A and group B (p< .05). The pregnancy resulted in the birth weight and delivered at gestational age compared with the normal cord insertions group, with lower birth weight (2820± 527gm vs 3144± 577gm, p < .05), and delivered at an earlier gestational age (38.0 ± 1.55 weeks vs. 38.8 ± 2.34 weeks, p < .05) was found in the VCI group. Conclusions: The strength of our study is that we focused solely on the hemodynamic changes in umbilical vein blood flow during isolated aPCI. Previous literature has reported only prenatal outcomes of aPCI for poor prognosis; however, we observed lower umbilical vein blood flow volume with aPCI. Hence, we propose UVBF analysis to evaluate fetal the aPCI according to umbilical vein hemodynamics as an advisory in prenatal care. This would be useful and would improve the clinical explanation of obstetricians about the potential prenatal consequences so that parents can opt for future prenatal care during pregnancy.