{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:01:18Z","timestamp":1791813678204,"version":"4.3.4"},"reference-count":52,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,9,4]],"date-time":"2018-09-04T00:00:00Z","timestamp":1536019200000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the association between abnormal cord insertion and the development of twin\u2010specific complications, including birth\u2010weight discordance, selective fetal growth restriction (sFGR) and twin\u2010to\u2010twin transfusion syndrome (TTTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a single center retrospective cohort study of twin pregnancies. Abnormal cord insertion was defined as either marginal (umbilical cord attachment site less than 2\u2009cm to the nearest margin of the placental disc) or velamentous (cord attached to the membrane before reaching the placental disc with clear evidence of vessels traversing the membranes to connect with the placental disc), as described in placental pathology reports. Twins with major structural or chromosomal abnormalities and monochorionic monoamniotic twins were not included in the study. Information on the pregnancies, ultrasound findings, prenatal investigations and interventions was obtained from the electronic ultrasound database, while data on placental histopathological findings, pregnancy outcome, mode of delivery, birth weight, gestational age at delivery and admission to the neonatal intensive care unit were obtained from maternity records. Categorical variables were compared using the chi\u2010square or Fisher's exact test, while continuous variables were compared using the Student's <jats:italic>t<\/jats:italic>\u2010test, ANOVA for multiple comparisons and the Kruskal\u2013Wallis test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 497 twin pregnancies included in the analysis, 351 (70.6%) were dichorionic and 146 (29.4%) were monochorionic. The incidence of birth\u2010weight discordance of 25% or more was significantly higher in pregnancies with velamentous and those with marginal cord insertions compared to those with normal cord insertion (24.0%, 15.3% <jats:italic>vs<\/jats:italic> 7.6%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001 and <jats:italic>P<\/jats:italic>\u00a0=\u20090.020, respectively). In pregnancies with birth\u2010weight discordance of 25% or more, the smaller twins had significantly higher prevalence of velamentous (13.8%) and marginal (34.2%) cord insertions compared with the larger twins (1.8% and 18.5%, respectively, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001). The smaller twins of the monochorionic diamniotic pregnancies showed an even higher prevalence of velamentous (29.5%) and marginal (40.9%) cord insertions compared with the larger twins (2.3% and 31.5%, respectively, <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001). Compared with the normal cord insertion group, only velamentous insertion was associated significantly with the risk of sFGR (odds ratio (OR), 9.24 (95% CI, 2.05\u201358.84), <jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001) and birth\u2010weight discordance of 20% or more (OR, 4.34 (95% CI, 1.36\u201314.61), <jats:italic>P<\/jats:italic>\u00a0=\u20090.007) and 25% or more (OR, 6.81 (95% CI, 1.67\u201334.12), <jats:italic>P<\/jats:italic>\u00a0=\u20090.003) in monochorionic twin pregnancies. There was no significant association between velamentous cord insertion and TTTS (<jats:italic>P<\/jats:italic>\u00a0=\u20090.591), or between marginal cord insertion and the development of sFGR (<jats:italic>P<\/jats:italic>\u00a0=\u20090.233), birth\u2010weight discordance of 25% or more (<jats:italic>P<\/jats:italic>\u00a0=\u20090.114) or TTTS (<jats:italic>P<\/jats:italic>\u00a0=\u20090.487). Subgroup analysis of dichorionic twins showed that abnormal cord insertion was not associated with the risk of birth\u2010weight discordance (<jats:italic>P<\/jats:italic>\u00a0=\u20090.999), sFGR (<jats:italic>P<\/jats:italic>\u00a0=\u20090.308), composite neonatal adverse outcome (<jats:italic>P<\/jats:italic>\u00a0=\u20090.637) or intrauterine death (<jats:italic>P<\/jats:italic>\u00a0=\u20090.349).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Monochorionic twins with velamentous cord insertion are at increased risk of birth\u2010weight discordance and sFGR. Sonographic delineation of placental cord insertion could be of value in the antenatal stratification of twin pregnancies. Prospective studies are required to assess the value and predictive accuracy of this potential screening marker. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.18914","type":"journal-article","created":{"date-parts":[[2017,10,4]],"date-time":"2017-10-04T14:32:43Z","timestamp":1507127563000},"page":"378-384","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":72,"title":["Significance of placental cord insertion site in twin pregnancy"],"prefix":"10.1002","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0658-138X","authenticated-orcid":false,"given":"E.","family":"Kalafat","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology Ankara University Faculty of Medicine  Ankara Turkey"},{"name":"Fetal Medicine Unit St George's Hospital, St\u00a0George's University of London  London UK"},{"name":"Vascular Biology Research Center Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Thilaganathan","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's Hospital, St\u00a0George's University of London  London UK"},{"name":"Vascular Biology Research Center Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Papageorghiou","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's Hospital, St\u00a0George's University of London  London UK"},{"name":"Vascular Biology Research Center Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-7501","authenticated-orcid":false,"given":"A.","family":"Bhide","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's Hospital, St\u00a0George's University of London  London UK"},{"name":"Vascular Biology Research Center Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2802-7670","authenticated-orcid":false,"given":"A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Fetal Medicine Unit St George's Hospital, St\u00a0George's University of London  London UK"},{"name":"Vascular Biology Research Center Molecular and Clinical Sciences Research Institute, St George's University of London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,4]]},"reference":[{"key":"e_1_2_5_2_1","article-title":"Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta\u2010analysis","volume":"354","author":"Cheong\u2010See F","year":"2016","journal-title":"BMJ"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001338"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.04.031"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11110"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.02.024"},{"key":"e_1_2_5_7_1","first-page":"449","article-title":"Intertwin birth\u2010weight discordance as a potential adaptive measure to promote gestational age","volume":"48","author":"Blickstein I","year":"2003","journal-title":"J Reprod Med"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.126961"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-199912000-00019"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000104060.37475.29"},{"key":"e_1_2_5_11_1","first-page":"474","article-title":"Fetal and neonatal mortality among twin gestations in the United States: the role of intrapair birth\u2010weight discordance","volume":"100","author":"Demissie K","year":"2002","journal-title":"Obstet Gynecol"},{"key":"e_1_2_5_12_1","first-page":"504","article-title":"Birth\u2010weight discordance, intrauterine growth retardation and perinatal outcomes in twins","volume":"39","author":"Fraser D","year":"1994","journal-title":"J Reprod Med"},{"key":"e_1_2_5_13_1","first-page":"203","article-title":"Growth discordancy in twin pregnancies: a risk factor not detected by measurements of biparietal diameter","volume":"66","author":"Erkkola R","year":"1985","journal-title":"Obstet Gynecol"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4643"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13062"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.15821"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000313300"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-1501"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2016.09.009"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070380"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.06.077"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01734-3"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2016.04.007"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.10.865"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1159\/000381639"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2001.00220.x"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(00)01111-X"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/13.10.2933"},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2010.02.018"},{"key":"e_1_2_5_30_1","first-page":"569","article-title":"The role of velamentous cord insertion in the etiology of twin\u2010twin transfusion syndrome","volume":"81","author":"Fries MH","year":"1993","journal-title":"Obstet Gynecol"},{"key":"e_1_2_5_31_1","first-page":"785","article-title":"Velamentous cord insertion in monochorionic twin gestation. An added risk factor","volume":"42","author":"Machin GA","year":"1997","journal-title":"J Reprod Med"},{"key":"e_1_2_5_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(92)91340-G"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0143-4004(98)90102-3"},{"key":"e_1_2_5_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.06.054"},{"key":"e_1_2_5_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4419-7494-5"},{"key":"e_1_2_5_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17347"},{"key":"e_1_2_5_37_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7200292"},{"key":"e_1_2_5_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2011.12.004"},{"key":"e_1_2_5_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2006.01.015"},{"key":"e_1_2_5_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2009.12.024"},{"key":"e_1_2_5_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2008.08.019"},{"key":"e_1_2_5_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2011.06.075"},{"key":"e_1_2_5_43_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12412"},{"key":"e_1_2_5_44_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2002.125745"},{"key":"e_1_2_5_45_1","first-page":"570","article-title":"The effect of birth\u2010weight discordance on twin neonatal mortality","volume":"101","author":"Branum AM","year":"2003","journal-title":"Obstet Gynecol"},{"key":"e_1_2_5_46_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000104060.37475.29"},{"key":"e_1_2_5_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.07.025"},{"key":"e_1_2_5_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.05.053"},{"key":"e_1_2_5_49_1","first-page":"e1","article-title":"Management of monochorionic twin pregnancy","volume":"124","author":"Kilby MD","year":"2016","journal-title":"BJOG"},{"key":"e_1_2_5_50_1","doi-asserted-by":"publisher","DOI":"10.1067\/S0002-9378(03)00811-1"},{"key":"e_1_2_5_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2013.04.005"},{"key":"e_1_2_5_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2193"},{"key":"e_1_2_5_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2012.05.003"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.18914","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.18914","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.18914","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.18914","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T18:17:58Z","timestamp":1692469078000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.18914"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9]]},"references-count":52,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,9]]}},"alternative-id":["10.1002\/uog.18914"],"URL":"https:\/\/doi.org\/10.1002\/uog.18914","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9]]},"assertion":[{"value":"2017-05-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}