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Jonathan Rosenfeld
J.D

May 4, 2023

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With a normal cord insertion, the umbilical cord connects to the center of the placenta. The center is the most secure place of attachment. Normal attachment supports the seamless flow of nutrients from the mother to the placenta and the fetus.

Marginal umbilical cord insertion (MCI), also known as battledore placenta or marginal cord insertion, affects the health of newborn babies and can cause them a lot of pain. During delivery, if the umbilical cord is inserted too far into the baby’s abdomen, it can cause severe birth injury.

The condition poses a significant risk to the baby and might result in bruising, tearing of the walls of the intestines, or even an intestinal fistula. Even though these complications are rare, your baby may need to stay in the neonatal intensive care unit (NICU) to receive additional nurturing until they are healthy enough to be moved to the nursery.

Birth Injuries from Marginal Cord Insertion

How Marginal Placental Cord Insertion Develops

Marginal placental cord insertion occurs during the development of a fetus in the womb. During this process, the umbilical cord connects and runs from the baby’s abdomen to the placenta inside the mother’s womb.

In some cases, the cord is inserted too close to or even within the developing placenta itself, rather than a healthy distance away from this vital organ responsible for providing nutrients to the baby in utero. Marginal insertion can lead to severe complications, including intrauterine growth restriction [1], stillbirths, and preterm births.

For doctors to detect marginal placental cord insertion early in pregnancy, ultrasounds and other tests may be used to observe fetal growth and placental health more closely. Treatments for marginal placental cord insertion include bed rest or hospitalization for constant medical monitoring if necessary.

What Qualifies as a Marginal Insertion of The Umbilical Cord?

The exact causes of MCI are unknown, but it is more likely with multiple pregnancies and fertility treatments or:

  • Using ART (artificial reproductive technology)
  • Nulliparity (first time birthing a child)
  • Advanced mater age (35 years and older)

While marginal cord insertion does not cause any physical symptoms, it can be diagnosed with a prenatal ultrasound and physical examination.

Having one or more of these factors doesn’t mean you’ll experience umbilical cord abnormalities. For instance, many people who use ART have normal cord insertions.

Complications from marginal cord insertion include reduced fetal blood flow, increased risk of spontaneous abortion, excessive bleeding during vaginal childbirth, and placenta previa [2].

Additionally, MCI can increase the chances of developing vasa previa. Such a condition can be especially dangerous if vaginal delivery is attempted without this condition first being diagnosed. When the amniotic sac ruptures, the fetal blood vessels will also rupture.

As a result, the baby will experience tremendous blood loss, resulting in birth injury and even death.

How Common is Marginal Cord Insertion?

Marginal cord insertion occurs when the umbilical cord connects to the edge of the placenta rather than the center. It is more common in multiple births than single pregnancies, with occurrence rates ranging from 2% to 25%.

This condition can become velamentous, especially during the third trimester. Velamentous cord insertion [3] is less common and more concerning than MCI, occurring in approximately 1% of pregnancies.

Certain factors may increase the likelihood of an atypical umbilical cord attachment. Your medical provider must monitor umbilical cord attachment if you are diagnosed with marginal or velamentous cord insertion.

Signs and Symptoms of Marginal Cord Insertion

MCI is a condition in which the umbilical cord attaches to the edge of the placenta instead of the center. It can often go unnoticed until a routine prenatal scan, and it can cause complications during birth.

Symptoms may include blood vessel compression, placental abruption, excessive bleeding during birth, and decreased fetal development. Ultrasounds [4] can identify issues like slowed fetal development or apparent intrauterine restriction.

Healthcare providers should monitor the pregnancy for velamentous insertion and fetal distress due to decreased blood flow or vessel compression. Further tests may be recommended if MCI is suspected to confirm the diagnosis.

Treatment options vary depending on the severity of symptoms; however, some cases may require a cesarean (c-section) delivery to reduce the risk of complications. Symptoms of marginal cord insertion may not be noticed until the child is several months old, so parents must remain vigilant and watch for any signs that could indicate this condition.

Symptoms and Causes of Marginal Umbilical Cord Insertion

Abnormal cord insertions are a serious condition that can occur during pregnancy and has severe consequences if not detected and treated correctly. The condition occurs when the umbilical cord abnormally attaches to the placenta, making it difficult for healthcare providers to pinpoint precisely where the umbilical cord has attached.

Doppler imaging [5] is often used to visualize the blood flow between the placenta and fetus, which can help identify the insertion point. Ultrasound photos after delivery may also show MCI.

Pregnant women need to be aware of this condition and seek medical attention if they suspect something is wrong with their baby’s umbilical cord insertion. Early detection and treatment are key to ensuring a healthy pregnancy.

Possible Complications of Marginal Cord Insertions

Marginal cord insertion is a condition that occurs when the umbilical cord is inserted into the edge of the placenta instead of the center. It can lead to both mother and baby complications, including preterm birth, low birth weight, and an increased risk of pregnancy loss.

Fetal distress [6] and vasa previa are potential complications that can arise from marginal cord insertion.

In some cases, cesarean delivery may be recommended to protect the lives and health of both mother and child due to the risk of heavy bleeding or stillbirth. Early delivery may also be beneficial in cases where there is growth restriction or other serious complications associated with marginal cord insertion.

Additionally, marginal cord insertion can cause a child to be born at a low gestational age, increasing the baby’s health risks.

Can Marginal Cord Insertion Cause Birth Defects?

Marginal cord insertion is a condition in which the umbilical cord attaches to the edge of the placenta instead of the center. It can lead to complications during pregnancy and birth, including low birth weight, preterm labor, and oxygen deprivation [7]. These issues can cause serious health problems for the baby, such as breathing difficulties, heart defects, and cerebral palsy.

Marginal cord insertion is most common in multiple pregnancies but can also occur in single pregnancies due to certain risk factors. These include:

  • Drug abuse during pregnancy
  • Chronic disease
  • Advanced maternal age
  • Nulliparity (never having been pregnant before)
  • Using an IUD before pregnancy
  • Using assisted reproductive technology (ART) to get pregnant.

It’s important to note that having one or more of these risk factors does not guarantee an abnormal cord insertion; many people with irregular cord insertions have healthy pregnancies.

Marginal Cord Insertion Diagnosis

Marginal cord insertion is a condition that occurs when the umbilical cord inserts into the edge of the placenta rather than in its center. It can cause decreased blood flow to the fetus and vessel compression, leading to fetal distress.

Diagnosis of marginal cord insertion typically occurs through an ultrasound scan during pregnancy. Healthcare providers should monitor for signs of velamentous insertion and fetal distress due to decreased blood flow or vessel compression.

To diagnose marginal cord insertion, careful monitoring of both mother and baby is necessary. The mother may need regular screenings to detect any pregnancy-related changes or problems. It is of clinical importance to have a sonographic prenatal diagnosis done by an ultrasound technician so your doctor can monitor the situation.

Symptoms of marginal cord insertion can include blood vessel compression, excessive bleeding during birth, and decreased blood flow to the fetus. Slowed fetal development or apparent intrauterine growth restriction may be identified during an ultrasound.

However, marginal cord insertion may go unnoticed until a routine prenatal scan [8]. If left untreated, this condition can lead to serious complications for both mother and baby, such as preterm labor or stillbirth.

Compensation and Marginal Cord Insertions

Marginal cord insertion is a condition that occurs when the umbilical cord inserts into the edge of the placenta rather than in its center. It can cause complications during pregnancy [9] and delivery and, unfortunately, cannot be treated.

Compensation may be available if medical consequences occur due to a doctor’s failure to provide prompt treatment for marginal cord insertion. Doctors must take this condition seriously and carefully monitor pregnancies to prevent potential complications.

Failing to do so can have severe consequences for both mother and baby. Patients should always seek legal advice if they feel their doctor has failed to provide adequate care or treatment for marginal cord insertion. Our birth injury lawyers can advise you of your legal rights and options.

Can Marginal Cord Insertion Correct Itself?

Marginal cord insertion is a condition in which the umbilical cord attaches to the edge of the placenta. It can cause complications during pregnancy and childbirth, such as preterm birth, low birth weight, and a greater risk of pregnancy loss. It can also lead to fetal distress and vasa previa, which can be dangerous for both mother and baby.

In some cases, marginal cord insertion may correct itself if the placenta expands in a different direction. However, doctors should monitor the pregnancy carefully to ensure the baby’s size and growth are normal.

Outlook / Prognosis

Marginal cord insertion is a condition in which the umbilical cord connects to the edge of the placenta instead of its center.

While it can be concerning for expecting mothers, it does not necessarily pose risks to the pregnancy [10] or prevent the fetus from getting enough nutrients. Marginal cord insertion can correct itself as the pregnancy progresses.

Trusting your medical provider and following their advice when dealing with marginal cord insertion is essential. They will monitor the fetus’s development and guide how best to maintain your health during pregnancy.

Is Marginal Cord Insertion Considered High Risk?

While it can be considered a high-risk pregnancy, most cases result in healthy pregnancies and babies.

The biggest concern with marginal cord insertion is intrauterine growth restriction (IUGR), which increases the risk of a newborn with low birth weight, low Apgar score [11], and an increased chance of a NICU stay. Your medical provider may recommend a c-section if they’re concerned about risks to you or your baby.

Risk factors for marginal cord insertion include advanced maternal age, female fetuses, chronic maternal illness, and anomalous cord insertion. Multiple gestations (twins, triplets, etc.) are at an increased risk than single pregnancies.

The cause of marginal cord insertion is not yet known but may be related to the abnormal development of placental tissue during pregnancy. It’s vital for pregnant women to be aware of the risks associated with marginal cord insertion and to follow their provider’s advice for monitoring and managing any potential complications.

How Often Does Marginal Cord Insertion Turn into Velamentous Cord Insertion?

Marginal cord insertion is a common occurrence in pregnancy, occurring in 2-25% of pregnancies. It is more common in multiple births [12] than in single births. During the third trimester, marginal cord insertion can turn into velamentous cord insertion, which is less common and more concerning than marginal cord insertion. Velamentous cord insertion occurs in approximately 1% of pregnancies.

It is essential to monitor umbilical cord attachment to ensure the best outcomes with marginal and velamentous cord insertions. Your medical provider can use ultrasound imaging to check for changes in the umbilical cord attachment throughout your pregnancy. If there are any changes, your doctor may recommend additional monitoring or interventions to ensure your and your baby’s health.

What Questions Should I Ask My Doctor?

When it comes to pregnancy, it is essential to ask your doctor questions about ultrasounds, tests, diet, exercise, and sleep. Ultrasounds are a great way to monitor the baby’s growth and development throughout the pregnancy.

If you have been diagnosed with a marginal cord insertion, it is essential to discuss this condition with your doctor. A marginal cord insertion may require additional monitoring or care, but it is possible that it will not impact the pregnancy.

Many people with this diagnosis go on to deliver healthy babies. Your doctor can provide more information about the necessary steps for safe delivery. Asking questions about ultrasounds, tests, diet, exercise, and sleep can help ensure that you have all of the information you need for a healthy pregnancy. [13]

Conclusions

The findings of this study provide important insights into the effects of MCI on maternal, fetal, and neonatal morbidities. It was found that pregnancies with MCI should be closely monitored, and delivery should take place in a setting where rapid, intensive neonatal care can be provided.

Additionally, the prevalence of velamentous and marginal cord insertions in single pregnancies was 1.5% and 6.3%, respectively, with higher rates in multiple pregnancies. These two conditions are closely related and have common risk factors, with velamentous insertion being the more-severe condition.

It is essential to keep in mind that it is unlikely that a marginal cord insertion correct diagnosis will cure itself. But treatment and careful monitoring by your doctor can help the birth to go smoothly.

Additionally, it is essential to be aware of the risk factors associated with MCI and velamentous cord insertion to identify these conditions early on.

Resources: [1] NIH, [2] NIH, [3] NIH, [4] FDA, [5] Clinical Trials, [6] PubMed, [7] American Psychological Association, [8] NIH, [9] Johns Hopkins, [10] Lousiana Department of Health, [11] Johns Hopkins, [12] CDC, [13] Health.gov, [14] PubMed

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