{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:27:34Z","timestamp":1788355654084,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["1U01HD087177\u201001"],"award-info":[{"award-number":["1U01HD087177\u201001"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the relationship between umbilical cord insertion site, placental pathology and adverse pregnancy outcome in a cohort of normal and complicated pregnancies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sonographic measurement of the cord insertion and detailed placental pathology were performed in 309 participants. Associations between cord insertion site, placental pathology and adverse pregnancy outcome (pre\u2010eclampsia, preterm birth, small\u2010for\u2010gestational age) were examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 93 (30%) participants were identified by pathological examination to have a peripheral cord insertion site. Only 41 of the 93 (44%) peripheral cords were detected by prenatal ultrasound. Peripherally inserted cords were associated significantly (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001) with diagnostic placental pathology (most commonly with maternal vascular malperfusion (MVM)); of which 85% had an adverse pregnancy outcome. In cases of isolated peripheral cords, without placental pathology, the incidence of adverse outcome was not statistically different when compared to those with central cord insertion and no placental pathology (31% <jats:italic>vs<\/jats:italic> 18%; <jats:italic>P<\/jats:italic>\u2009=\u20090.3). A peripheral cord with an abnormal umbilical artery (UA) pulsatility index (PI) corresponded to an adverse outcome in 96% of cases compared to 29% when the UA\u2010PI was normal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates that peripheral cord insertion is often part of the spectrum of findings of MVM disease and is associated with adverse pregnancy outcome. However, adverse outcome was uncommon when there was an isolated peripheral cord insertion and no placental pathology. Therefore, additional sonographic and biochemical features of MVM should be sought when a peripheral cord is observed. \u00a9 2023 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.26206","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T09:13:29Z","timestamp":1679908409000},"page":"248-254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Peripheral cord insertion is associated with adverse pregnancy outcome only when accompanied by clinically significant placental pathology"],"prefix":"10.1002","volume":"62","author":[{"given":"D.","family":"Stapleton","sequence":"first","affiliation":[{"name":"Department of Chemistry Memorial University of Newfoundland, St John's, NL  Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Darmonkow","sequence":"additional","affiliation":[{"name":"Department of Chemistry Memorial University of Newfoundland, St John's, NL  Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ravi Chandran","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Milligan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Paediatrics The Hospital for Sick Children  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Saghian","sequence":"additional","affiliation":[{"name":"Mouse Imaging Centre The Hospital for Sick Children  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Shinar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8267-1630","authenticated-orcid":false,"given":"C. L.","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto ON Canada"},{"name":"Pregnancy Research Centre, Department of Obstetrics and Gynaecology Royal Women's Hospital  Parkville Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. R.","family":"Hobson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Serghides","sequence":"additional","affiliation":[{"name":"Toronto General Hospital Research Institute University Health Network  Toronto ON Canada"},{"name":"Department of Immunology and Institutes of Medical Sciences University of Toronto  Toronto ON Canada"},{"name":"Women's College Research Institute Women's College Hospital  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. K.","family":"Macgowan","sequence":"additional","affiliation":[{"name":"Translational Medicine The Hospital for Sick Children  Toronto ON Canada"},{"name":"Department of Medical Biophysics University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-283X","authenticated-orcid":false,"given":"J. G.","family":"Sled","sequence":"additional","affiliation":[{"name":"Mouse Imaging Centre The Hospital for Sick Children  Toronto ON Canada"},{"name":"Translational Medicine The Hospital for Sick Children  Toronto ON Canada"},{"name":"Department of Medical Biophysics University of Toronto  Toronto ON Canada"},{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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