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Abnormal placental cord insertion and adverse pregnancy outcomes:a systematic review and meta-analysis

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dc.contributor.author Ismail, Khadijah I.
dc.contributor.author Hannigan, Ailish
dc.contributor.author O'Donoghue, Keelin
dc.contributor.author Cotter, Amanda
dc.date.accessioned 2019-01-08T19:10:30Z
dc.date.available 2019-01-08T19:10:30Z
dc.date.issued 2017
dc.identifier.uri http://hdl.handle.net/10344/7456
dc.description peer-reviewed en_US
dc.description.abstract Background: Abnormal placental cord insertion (PCI) includes marginal cord insertion (MCI) and velamentous cord insertion (VCI). VCI has been shown to be associated with adverse pregnancy outcomes. This systematic review and meta-analysis aims to determine the association of abnormal PCI and adverse pregnancy outcomes. Methods: Embase, Medline, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and Cochrane Databases were searched in December 2016 (from inception to December 2016). The reference lists of eligible studies were scrutinized to identify further studies. Potentially eligible studies were reviewed by two authors independently using the following inclusion criteria: singleton pregnancies, velamentous cord insertion, marginal cord insertion, and pregnancy outcomes. Case reports and series were excluded. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Outcomes for meta-analysis were dichotomous and results are presented as summary risk ratios with 95% confidence intervals. Results: Seventeen studies were included in the systematic review, all of which were assessed as good quality. Normal PCI and MCI were grouped together as non-VCI and compared with VCI in seven studies. Four studies compared MCI, VCI, and normal PCI separately. Two other studies compared MCI with normal PCI, and VCI was excluded from their analysis. Studies in this systematic review reported an association between abnormal PCI, defined differently across studies, with preterm birth, small for gestational age (SGA), low birthweight (< 2500 g), emergency cesarean delivery, and intrauterine fetal death. Four cohort studies comparing MCI, VCI, and normal PCI separately were included in a meta-analysis resulting in a statistically significant increased risk of emergency cesarean delivery for VCI (pooled RR 2.86, 95% CI 1.56–5.22, P = 0.0006) and abnormal PCI (pooled RR 1.77, 95% CI 1.33–2.36, P < 0.0001) compared to normal PCI. Conclusions: The available evidence suggests an association between abnormal PCI and emergency cesarean delivery. However, the number of studies with comparable definitions of abnormal PCI was small, limiting the analysis of other adverse pregnancy outcomes, and further research is required. en_US
dc.language.iso eng en_US
dc.publisher BMC en_US
dc.relation.ispartofseries Systematic Reviews;6:242
dc.relation.uri http://dx.doi.org/10.1186/s13643-017-0641-1
dc.subject abnormal placental cord insertion en_US
dc.subject marginal placental cord insertion en_US
dc.subject velamentous placental cord insertion en_US
dc.subject adverse pregnancy outcomes en_US
dc.subject small for gestational age en_US
dc.subject emergency cesarean delivery en_US
dc.title Abnormal placental cord insertion and adverse pregnancy outcomes:a systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1186/s13643-017-0641-1
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 2892338


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