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. 2023 Jul 26;26(3):157-168.
doi: 10.1002/ajum.12360. eCollection 2023 Aug.

Current practice of placental cord insertion documentation in Australia - A sonographer survey

Samantha Ward  1 , Zhonghua Sun  1 , Sharon Maresse  1
Affiliations

Current practice of placental cord insertion documentation in Australia - A sonographer survey

Samantha Ward et al. Australas J Ultrasound Med. .

Abstract

Introduction: During pregnancy, the umbilical cord attaches to the placenta in a central, eccentric, marginal or velamentous location. Maternal and fetal complications are associated with marginal and velamentous cord insertions, the most clinically significant being perinatal mortality due to undiagnosed vasa praevia. Current literature describes a wide variation regarding regulation of placental cord insertion (PCI) documentation during antenatal ultrasound examinations. This prospective cross-sectional study aimed to assess the current practice of antenatal PCI documentation in Australia.

Methods: Members of the Australian Sonographer Accreditation Registry were invited to participate in an online survey which was distributed between February and March 2022.

Results: Four hundred ninety sonographers met the inclusion criteria for the study of which 330 (67.3%) have more than 10 years' experience as a sonographer and 375 (76.5%) are employed primarily in a public or private setting offering general ultrasound. Most respondents (89.6%) indicated documentation of the PCI site is departmental protocol at the second trimester anatomy scan (17-22 weeks gestation), but PCI documentation is protocol in less than 50% of other obstetric ultrasound examinations listed in the survey. The PCI site is included in the formal ultrasound report at a rate significantly less than inclusion in the departmental protocol and the sonographer's worksheet.

Conclusions: Considering the potential maternal and fetal complications associated with abnormal PCI and the ease at which the PCI site is identified in the first and second trimesters, we believe that standard inclusion of the PCI site in departmental protocol and in the formal ultrasound report from 11 weeks gestation, regardless of whether it is normal or abnormal, would prove invaluable.

Keywords: eccentric; marginal; placental cord insertion; protocol; sonographer; ultrasound; vasa praevia; velamentous.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Marginal placental cord insertion in first trimester.
Figure 2
Figure 2
Velamentous cord insertion in first trimester, longitudinal view.
Figure 3
Figure 3
Marginal placental cord insertion in second trimester, longitudinal view.
Figure 4
Figure 4
Velamentous placental cord insertion in second trimester. (a) Transabdominal view (b) Associated vasa praevia demonstrated on transvaginal view.
Figure 5
Figure 5
Third trimester marginal placental cord insertion, longitudinal image.
Figure 6
Figure 6
(a) Velamentous placental cord insertion in third trimester and (b) the placenta after delivery.
Figure 7
Figure 7
Sonographer documentation of the placental cord insertion site if not specified by departmental protocol (%).
Figure 8
Figure 8
Sonographers' opinions on the value of placental cord insertiondocumentation (n).
See this image and copyright information in PMC

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