Marginal Cord Insertion- Causes, Signs and Symptoms, Diagnosis, and Treatment

Introduction

During pregnancy, on or around the center of the placenta, the umbilical cord is attached, and this vital organ will provide oxygen and nutrients to the growing fetus. Sometimes, the umbilical cord is attached to the wrong place on the side of the placenta instead of in the middle. Marginal cord insertion is also known as battledore cord insertion or battledore placenta. This marginal umbilical cord insertion can cause problems for the expecting mothers and their babies. The same level of support cannot be provided to the umbilical cord by the placenta as the sides of the placenta are not as strong as the center area. This marginal cord insertion can lead to a reduction of blood flow to the fetus, which will increase the risk of developmental challenges and birth injuries. The occurrence of marginal cord insertion on average is seven percent of pregnancies.

What Causes Marginal Cord Insertion?

The causes of marginal cord insertion aren’t sure by the research. There are certain factors that might increase the likelihood of an atypical umbilical cord attachment. It is more common in pregnancy with twins or triplets. The other factors may include drug abuse during pregnancy, advanced maternal age 35 or older, having a chronic disease such as diabetes, nulliparity before pregnancy using an intrauterine device, and using artificial reproductive technology to get pregnant.

What Are the Signs and Symptoms of Marginal Cord Insertion?

A pregnant woman, in many cases of marginal cord insertion, will not notice any obvious problems, and often, it can go unnoticed until a routine prenatal scan is done. Healthcare providers can identify issues during an ultrasound, such as slowed fetal development or apparent intrauterine growth restriction. When they arise, symptoms may include such as:

• Bleeding excessively while giving birth.

• Compression of blood vessels.

• Decrease blood flow to the fetus, leading to decreased fetal development.

What Are the Risk Factors of Marginal Cord Insertion?

Multiple gestations, such as twins and triplets, will have more risk of marginal cord insertion than single pregnancies. Researchers are unsure about the cause of marginal cord insertion, but studies suggest that it might be due to the abnormal development of placental tissue during pregnancy. Risk factors can include female fetuses, advanced maternal age, maternal chronic illness, and pregnancies with anomalous cord insertion.

What Are the Possible Complications of Marginal Cord Insertion?

There are many possible complications, as marginal cord insertion is relatively common. The doctors must monitor this condition carefully and treat it appropriately. Possible complications that can arise are:

• Low Birth Weight: There can be slowed fetal growth or development due to marginal cord insertion, leading to lower birth weight. Additional support might be required for infants with lower birth weight after birth, which includes feeding.

• Preterm Birth: Patients might deliver early in the pregnancy in many cases with marginal cord insertion. There can be complications with preterm birth, such as preterm infants might need extra support.

• Fetal Distress: There can be overall reduced blood flow with marginal cord insertion, which can cause fetal distress. There can be decreased fetal movement or changes in the baby's heart rate. There might be a need for immediate delivery sometimes in fetal distress.

• Greater Odds of Pregnancy Loss: Abortion occurring spontaneously is of greater risk due to marginal cord insertion during the first or second trimester.

• Vasa Previa: There can be rupture during early labor when the marginal insertion occurs near the cervix in extreme cases, which will potentially lead to stillbirth. The risk of vasa previa can be decreased by C-section sometimes and protects both mother and child.

• Excessive Bleeding During Childbirth: During delivery, blood vessels might rupture, which leads to an increased risk of placental abruption.

Can Marginal Cord Insertion Cause Birth Defects?

There can be developmental problems and fetal growth due to marginal cord insertion, and this can lead to some types of birth defects that include low birth weight. It can also cause the child to be born at a low gestational age which can increase the risk to the baby’s health. There can be breathing, heart and brain issues, and also other problems in preterm infants. There can also be an increased risk of cerebral palsy with marginal cord insertion, and it occurs due to oxygen deprivation during pregnancy or birth. Cerebral palsy will impact muscle tone, balance, and posture. Cerebral palsy children might need help while walking or be unable to walk at all.

How Is Marginal Cord Insertion Diagnosed?

During routine scans that are via ultrasound, doctors usually diagnose marginal cord insertion. The blood flow from the placenta through the umbilical cord is seen with ultrasound by the technician, who should recognize if something is wrong. Accordingly, doctors can develop a treatment plan. Once the doctor diagnoses marginal cord insertion, the pregnancy should be carefully monitored to ensure that there is no development of velamentous insertion, and

due to decreased blood flow or blood vessel compression, the fetus does not suffer distress. Healthcare providers will monitor the delays in growth. During pregnancy at any point, complications can develop, and quick interventions may help decrease many of the risks.

What Are the Possible Treatment Options for Marginal Cord Insertion?

Marginal cord insertion cannot be fully corrected with the treatment. However, many healthcare providers will recommend that specific steps should be taken that will help to protect the pregnancy. These include:

• Increases Scans and Tests: The marginal cord insertion is more carefully monitored to ensure that further complications do not develop.

• Early Delivery: Though there are potential preterm complications with preterm birth, it can prove beneficial to deliver the infant early when there are cases of growth restrictions and other serious complications.

• C-Section: C-section delivery might be recommended by doctors to protect the health of both the mother and child. This is due to the reason that marginal insertion can increase the risk of heavy bleeding or stillbirth.

Conclusion

Marginal cord insertion, in some cases, can be corrected by itself. In different directions, the placenta can be expanded than anticipated, which causes the cord to shift over time. Many women continue to have healthy pregnancies, but doctors should continue to monitor the pregnancy by keeping an eye on the baby's growth and size.