Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 PregnanciesReport as inadecuate




Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions: A Population-Based Study of 634,741 Pregnancies - Download this document for free, or read online. Document in PDF available to download.

Objectives

To determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.

Design

Population-based registry study.

Setting

Medical Birth Registry of Norway 1999–2009.

Population

All births gestational age >16 weeks to <45 weeks in Norway 623,478 singletons and 11,263 pairs of twins.

Methods

Descriptive statistics and odds ratios ORs for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.

Main outcome measures

Velamentous or marginal cord insertion. Abruption of the placenta, placenta praevia, pre-eclampsia, preterm birth, operative delivery, low Apgar score, transferral to neonatal intensive care unit NICU, malformations, birthweight, and perinatal death.

Results

The prevalence of abnormal cord insertion was 7.8% 1.5% velamentous, 6.3% marginal in singleton pregnancies and 16.9% 6% velamentous, 10.9% marginal in twins. The two conditions shared risk factors; twin gestation and pregnancies conceived with the aid of assisted reproductive technology were the most important, while bleeding in pregnancy, advanced maternal age, maternal chronic disease, female foetus and previous pregnancy with anomalous cord insertion were other risk factors. Velamentous and marginal insertion was associated with an increased risk of adverse outcomes such as placenta praevia OR = 3.7, 95% CI = 3.1–4.6, and placental abruption OR = 2.6, 95% CI = 2.1–3.2. The risk of pre-eclampsia, preterm birth and delivery by acute caesarean was doubled, as was the risk of low Apgar score, transferral to NICU, low birthweight and malformations. For velamentous insertion the risk of perinatal death at term was tripled, OR = 3.3 95% CI = 2.5–4.3.

Conclusion

The prevalence of velamentous and marginal insertions of the umbilical cord was 7.8% in singletons and 16.9% in twin gestations, with marginal insertion being more common than velamentous. The conditions were associated with common risk factors and an increased risk of adverse perinatal outcomes; these risks were greater for velamentous than for marginal insertion.



Author: Cathrine Ebbing , Torvid Kiserud, Synnøve Lian Johnsen, Susanne Albrechtsen, Svein Rasmussen

Source: http://plos.srce.hr/



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