A systematic review and meta-analysis of velamentous cord insertion among singleton pregnancies and the risk of preterm delivery.

BACKGROUND

Observational studies have reported varying results about the association of velamentous cord insertion (VCI) with adverse pregnancy outcomes.

OBJECTIVES

To evaluate the risk of preterm delivery among singleton pregnancies complicated by VCI.

SEARCH STRATEGY: Various databases were searched for English-language articles published up to February, 28, 2017, using keywords including VCI; abnormal placentation; abnormal cord insertions; adverse perinatal outcomes; and preterm birth. Outcome measures included preterm delivery; pre-eclampsia; cesarean delivery; fetal demise in utero (FDIU); and small for gestational age (SGA).

SELECTION CRITERIA: Only studies involving VCI were included in the meta-analysis.

DATA COLLECTION AND ANALYSIS: Analyses were performed using RevMan version 5.3.5 (The Nordic Cochrane Centre, Copenhagen, Denmark).

MAIN

RESULTS

There were six studies included in the analysis. The VCI and control groups comprised 16 295 and 1 366 485 women, respectively. An increased incidence of preterm delivery was found for the VCI group compared with the control group (11.8% vs 7.0%; adjusted odds ratio [aOR] 1.95, 95% confidence interval [CI] 1.85-2.04). A diagnosis of VCI was also associated with cesarean delivery (aOR 1.17, 95% CI 1.12-1.23), SGA (aOR 1.93, 95% CI 1.83-2.04), and FDIU (aOR 3.96, 95% CI 3.21-4.89).

CONCLUSION

The presence of VCI was associated with adverse pregnancy outcomes.