Accuracy of fetal anatomy survey in the diagnosis of velamentous cord insertion: a case–control study
Received 4 October 2018
Accepted for publication 1 February 2019
Published 11 March 2019 Volume 2019:11 Pages 169—176
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Professor Elie Al-Chaer
William M Curtin,1,2 Jennifer M Hill,3,4 Karmaine A Millington,2 Odessa P Hamidi,5 Stephen S Rasiah,5 Serdar H Ural1,6
1Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA; 2Department of Pathology & Laboratory Medicine, Pennsylvania State University College of Medicine, Hershey, PA, USA; 3Pennsylvania State University College of Medicine, Hershey, PA, USA; 4Department of Obstetrics & Gynecology, St Francis Hospital and Medical Center, Hartford, CT, USA; 5Department of Obstetrics & Gynecology, Pennsylvania State University College of Medicine, Hershey, PA, USA; 6Department of Radiology, Pennsylvania State University College of Medicine, Hershey, PA, USA
Objective: Our objective was to determine the accuracy of ultrasound at the time of the fetal anatomy survey in the diagnosis of velamentous cord insertion (VCI).
Study design: This retrospective case–control study identified placentas with VCI (cases) and randomly selected placentas with normal placental cord insertion (PCI) (controls) as documented by placental pathology for mothers delivered from 2002 through 2015. Archived ultrasound images for PCI at the time of the fetal anatomy survey were reviewed. Data analysis was by calculation of sensitivity, specificity, and accuracy and their 95% CI for the ultrasound diagnosis of VCI.
Results: The prevalence of VCI was 1.6% of placentas submitted for pathologic examination. There were 122 cases of VCI and 347 controls with normal PCI. The performance criteria calculated for the diagnosis of VCI at the time of fetal anatomy survey were as follows: sensitivity 33.6%; 95% CI: 25.3, 42.7; specificity 99.7%; 95% CI: 98.4, 99.9 and accuracy 82.5; 95% CI: 80.5, 82.9.
Conclusion: The identification of a VCI at the time of fetal anatomy survey is highly specific for the presence of a VCI as documented by placental pathology. The sensitivity in this study was less than expected. Sensitivity could be improved by reducing the number of nonvisualized PCIs, creating an awareness of risk factors for VCI, and obtaining more detailed images in the case of an apparent marginal PCI.
Keywords: velamentous, placental cord insertion, placental pathology, sensitivity, specificity, accuracy
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