Influence of the placental cord insertion site on the placental mass and the birth weight in dichorionic diamniotic twins

Keywords: dichorionic diamniotic twins, placenta, placental cord insertion site, small for gestational age, new-borns’ birth weight


The aim of the study was to determine the effect of the displacement of the umbilical cord insertion site from the centre of the placenta on the placental mass and the birth weight of dichorionic diamniotic twins and to consider the importance of the direction of the displacement, as well as to assess the influence of the umbilical cord displacement on the placental mass and the birth weight of dichorionic diamniotic twins taking into account the direction of displacement.

Material and methods. The study was performed on 135 dichorionic diamniotic pairs: 68 opposite-sex, 35 same-sex males, and 32 same-sex females. The impact of an absolute cord displacement from the centroid of the placental disc and the direction of its shifting were compared with the birth weight and the placental mass.

Results. In the investigated group, a central insertion was revealed in 6 (2.2 %), eccentric – in 224 (83.0 %), marginal – in 31 (11.5 %), and velamentous – in 9 (3.3 %) cases. The first two types of cord insertion are considered to be normal, the third and the fourth are seen as abnormal. The placental mass was in a strong positive correlation with the birth weight (r=0.71, p<0.0001). The placentas with an eccentric cord insertion had a smaller surface area. A negative correlation was established between the displacement of the cord insertion site and the placental mass (r=-0.4284, p<0.0001) as well as the birth weight (r=-0.6115, p<0.0001). The shift along the long axis was of greater importance than in relation to the shorter one. The placental mass and the birth weight were higher in the new-borns with a normal cord insertion site. In the abnormal cord insertion group, 32.5 % of the infants were under the 10th birth weight percentile, in the normal cord insertion group – only 8.3 %.

Conclusions. The birth weight of dichorionic diamniotic twins and their placental mass are negatively correlated with the distance of the umbilical cord insertion site from the placental centre. The insertion site displacement along the long axis has a stronger negative effect on the birth weight and the placental mass in comparison with the shifting along the short axis. The placentas with an eccentric cord insertion have a smaller surface area.


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Author Biography

Iryna Tepla, Shupyk National Healthcare University of Ukraine

Department of Obstetrics and Gynecology No.1


Pison, G., D’Addato, A. V. (2006). Frequency of Twin Births in Developed Countries. Twin Research and Human Genetics, 9 (2), 250–259. doi:

Freedman, A. A., Hogue, C. J., Marsit, C. J., Rajakumar, A., Smith, A. K., Grantz, K. L. et. al. (2018). Associations Between Features of Placental Morphology and Birth Weight in Dichorionic Twins. American Journal of Epidemiology, 188 (3), 518–526. doi:

Grandi, C., Veiga, A., Mazzitelli, N., Cavalli, R., Cardoso, V. (2016). Placental Growth Measures in Relation to Birth Weight in a Latin American Population. Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 38 (8), 373–380. doi:

Chisholm, K. M., Folkins, A. K. (2016). Placental and Clinical Characteristics of Term Small-for-Gestational-Age Neonates: A Case-Control Study. Pediatric and Developmental Pathology, 19 (1), 37–46. doi:

Khong, T. Y., Mooney, E. E., Ariel, I., Balmus, N. C. M., Boyd, T. K., Brundler, M.-A. et. al. (2016). Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement. Archives of Pathology & Laboratory Medicine, 140 (7), 698–713. doi:

Salafia, C. M., Kiryankova, N., Inany, H., Charlagorla, P., Park, M., Khawar, N. et. al. (2016). Metabolic scaling and twin placentas. Placenta, 37, 16–18. doi:

De Paepe, M. E., Shapiro, S., Young, L. E., Luks, F. I. (2015). Placental weight, birth weight and fetal:placental weight ratio in dichorionic and monochorionic twin gestations in function of gestational age, cord insertion type and placental partition. Placenta, 36 (2), 213–220. doi:

Kalisch-Smith, J. I., Simmons, D. G., Dickinson, H., Moritz, K. M. (2017). Review: Sexual dimorphism in the formation, function and adaptation of the placenta. Placenta, 54, 10–16. doi:

Yampolsky, M., Salafia, C. M., Shlakhter, O., Haas, D., Eucker, B., Thorp, J. (2009). Centrality of the Umbilical Cord Insertion in a Human Placenta Influences the Placental Efficiency. Placenta, 30 (12), 1058–1064. doi:

Sunde, I. D., Vekseth, C., Rasmussen, S., Mahjoob, E., Collett, K., Ebbing, C. (2017). Placenta, cord and membranes: a dual center validation study of midwives’ classifications and notifications to the Medical Birth Registry of Norway. Acta Obstetricia et Gynecologica Scandinavica, 96 (9), 1120–1127. doi:

Suzuki, S., Kato, M. (2015). Clinical Significance of Pregnancies Complicated by Velamentous Umbilical Cord Insertion Associated With Other Umbilical Cord/Placental Abnormalities. Journal of Clinical Medicine Research, 7 (11), 853–856. doi:

Wiedaseck, S., Monchek, R. (2014). Placental and Cord Insertion Pathologies: Screening, Diagnosis, and Management. Journal of Midwifery & Women’s Health, 59 (3), 328–335. doi:

Ismail, K. I., Hannigan, A., O’Donoghue, K., Cotter, A. (2017). Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis. Systematic Reviews, 6 (1). doi:

Ravikumar, G., Crasta, J., Prabhu, J. S., Thomas, T., Dwarkanath, P., Thomas, A. et. al. (2018). Eccentric placentae have reduced surface area and are associated with lower birth weight in babies small for gestational age. Journal of Developmental Origins of Health and Disease, 9 (3), 281–286. doi:

Brouillet, S., Dufour, A., Prot, F., Feige, J.-J., Equy, V., Alfaidy, N. et. al. (2014). Influence of the Umbilical Cord Insertion Site on the Optimal Individual Birth Weight Achievement. BioMed Research International, 2014, 1–8. doi:

Folkehelseinstituttet. Veileder til utfylling av melding til Medisinsk fødselsregister 2014. Guide to completing the notification to the Medical Birth Registry (in Norwegian). Oslo: Folkehelseinstituttet.

Chen, Y., Zhang, Z., Wu, C., Davaasuren, D., Goldstein, J. A., Gernand, A. D., Wang, J. Z. (2020). AI-PLAX: AI-based placental assessment and examination using photos. Computerized Medical Imaging and Graphics, 84, 101744. doi:

Tepla, I. (2021). Comparative analysis of the neonate birth weight in different types of twin pregnancy. Medical Science of Ukraine (MSU), 17 (1), 35–46. doi:

Stirnemann, J., Villar, J., Salomon, L. J., Ohuma, E., Ruyan, P. et. al. (2017). International estimated fetal weight standards of the INTERGROWTH-21stProject. Ultrasound in Obstetrics & Gynecology, 49 (4), 478–486. doi:

Ebbing, C., Kiserud, T., Johnsen, S. L., Albrechtsen, S., Rasmussen, S. (2013). Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies. PLoS ONE, 8 (7), e70380. doi:

Haeussner, E., Schmitz, C., von Koch, F., Frank, H.-G. (2013). Birth weight correlates with size but not shape of the normal human placenta. Placenta, 34 (7), 574–582. doi:

Kowsalya, V., Vijayakuma, R., Valli, G., Bharath, K. P., Srikumar, R., Kumar, C. K. et. al. (2013). Morphometry Examination of Placenta in Birth Weight of Full-Term Newborns in Puducherry, India. Pakistan Journal of Biological Sciences, 16 (17), 895–897. doi:

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How to Cite
Tepla, I. (2021). Influence of the placental cord insertion site on the placental mass and the birth weight in dichorionic diamniotic twins. EUREKA: Health Sciences, (4), 3-11.
Medicine and Dentistry