Ultrasonographic evaluation of placental cord insertion at different gestational ages in low-risk singleton pregnancies: a predictive algorithm.
OBJECTIVE
To evaluate the accuracy of ultrasound in visualizing placental cord insertion (PCI) at different gestational ages in order to recommend the most feasible period during pregnancy to identify it. Secondary aim was to propose a predictive algorithm for PCI visualization.


METHODS
We performed a single-center, prospective cohort study. We enrolled patients with singleton low-risk pregnancies who underwent fetal ultrasound scan at different gestational ages. We excluded patients with body mass index of 30 Kg/m2 or more, uterine fibroids larger than 5 cm, high-risk pregnancies, fetal weight lower than < 10° percentile or higher than > 90° percentile, increased ("deep pocket" > 80 mm) or decreased ("deep pocket" < 20 mm) amniotic fluid.


RESULTS
Among the 468 recruited patients, the visualization of PCI was not possible in 5.77% of the cases. Furthermore, we showed that PCI visualization was lower as the gestational age increased (p = 0.049) and more difficult in case of posterior placenta (p = 0.001).


CONCLUSIONS
PCI should be evaluated in the first trimester or as early as possible during the second trimester. Moreover, we propose a feasible model to predict the possibility of PCI visualization according to gestational age and uterine site of implantation.
Department of Prenatal Diagnosis. Altamedica, Fetal-Maternal Medical Center, 00198 Rome (Italy).
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F
Padula
Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi". University of Messina, 98125 Messina (Italy).
A S
AS
Laganà
Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi". University of Messina, 98125 Messina (Italy).
S G
SG
Vitale
Department of Prenatal Diagnosis. Altamedica, Fetal-Maternal Medical Center, 00198 Rome (Italy).
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L
Mangiafico
Department of Prenatal Diagnosis. Altamedica, Fetal-Maternal Medical Center, 00198 Rome (Italy).
L
L
D'Emidio
Department of Prenatal Diagnosis. Altamedica, Fetal-Maternal Medical Center, 00198 Rome (Italy).
P
P
Cignini
Department of Prenatal Diagnosis. Altamedica, Fetal-Maternal Medical Center, 00198 Rome (Italy).
M
M
Giorlandino
Gynaecology and Obstetrics Section. Department of Medical Surgical Specialties. University of Catania, 95100 Catania (Italy).
F A
FA
Gulino
Department of Obstetrics and Gynaecology. Campus Bio Medico University of Rome, 00128 Rome (Italy).
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S
Capriglione
Department of Prenatal Diagnosis. Altamedica, Fetal-Maternal Medical Center, 00198 Rome (Italy).
C
C
Giorlandino
Accuracy; fetal ultrasound; placental cord insertion; predictive model; ultrasonography; umbilical cord