Objective:To predict the progression to velamentous cord insertion in mid-trimester by analyzing the ultra-sound characteristics of marginal cord insertion in the lower 1/3 segment of the uterus during the first trimester.Materials and Methods:From February 2018 to November 2022,102 pregnant women with marginal cord insertion in the lower 1/3 of the uterus diagnosed by ultrasound during the first trimester in our hospital were selected for the study,and were divided into 2 groups according to the distance of the cord insertion from the placental edge:≤5 mm(n=29 cases in group A)and＞5 mm(n=73 cases in group B),and the changes of the cord insertion were screened sequentially in two stages of first and mid-trimester to find out the ultrasound features of the progression from marginal cord insertion to velamentous cord insertion and the reasons for this were analyzed.Results:Among 102 pregnant women,there were 29 cases in group A and 73 cases in group B.Seven cases in group A progressed to velamentous cord insertion in mid-trimester,with an incidence of 24.13％,while no cases progressing to velamentous cord insertion were found in group B.Eight cases progressing to velamentous cord insertion were confirmed by clinical examination after birth,and one case was missed.Through observation and comparison,the ultrasound features of the progression of marginal cord insertion to velamentous cord insertion were:the umbilical cord at-tached to the lower 1/3 segment of the uterus in the first trimester,the position of umbilical cord insert was≤5mm from the edge of the placenta,the placenta was attached to the anterior wall of uterus in the mid-trimester,the position of placenta was normal,and the placenta was thinned or atrophied at the umbilical cord insert,the difference was statistically significant(P＜0.05).Conclusion:The marginal cord insertion of the umbilical cord attached to the lower 1/3 segment of the uterus dur-ing the first trimester may progress to velamentous cord insertion,and sequential screening for changes in the location of um-bilical cord insertion should be performed at both first and mid-trimester to improve the prenatal diagnosis rate of velamen-tous cord insertion and avoid missing the diagnosis of velamentous marginal insertion of the umbilical cord.
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