Placenta
Umbilical cord
Marginal insertion

Author: Paul J. Kowalski, M.D. (see Authors page)

Revised: 17 October 2017, last major update November 2015

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Marginal insertion umbilical cord
Cite this page: Kowalski, P.J. Marginal insertion. PathologyOutlines.com website. http://pathologyoutlines.com/topic/placentamarginalinsert.html. Accessed November 19th, 2017.
Definition / general
  • Generally refers to an umbilical cord insertion site located at or near the disc margin
Terminology
  • When directly at the disc margin (on the height or thickness dimensional aspect), the insertion is described as marginal or "battledore" (resembling a badminton racket)
  • When near the disc margin (on the width dimensional aspect), the insertion is described as peripheral or eccentric
Epidemiology
  • Marginal insertions occur in approximately 8% of singleton gestations
  • Occur in 20 - 30% of twin pregnancies, with higher incidences in monochorionic twins
Etiology
  • Developing placental disc demonstrates migrational tropism towards the uterine vascular supply
  • When the uterine vascular supply is asymmetric, the disc will migrate in relation to the relatively stationary umbilical cord, resulting in a cord insertion site that is no longer centrally located
  • Competition among twins for the uterine vascular supply can also result in asymmetric placental development and a marginally or peripherally located umbilical cord
Clinical features
  • Fetal growth restriction and the presence of a single umbilical artery (two vessel umbilical cord) are slightly increased with marginal insertions
  • Major chorionic vessels (that would normally insert on the disc more centrally) can instead transverse the adjacent membranes, are termed aberrant membrane vessels and are at risk for rupture
  • Marginal vessels are more likely to undergo twisting, occlusion or thrombosis
  • Discordant growth or fetal growth restriction may be seen with affected twin pregnancies
Case reports
Gross description
  • Umbilical cord insertion will occur at or near the disc margin
  • Aberrant membrane vessels may be present and may show evidence of rupture, hemorrhage or thrombosis
Gross images

Images hosted on other servers:
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Marginal "battledore" insertion

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Marginal insertion

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Various images

Microscopic (histologic) description
  • Hemosiderin laden macrophages may be seen in the membranes or adjacent to vessels that have undergone rupture or thrombosis