Impact of velamentous cord insertion on perinatal outcomes: a systematic review and meta-analysis

• Published in: American journal of obstetrics & gynecology MFM 2023-02, Vol.5 (2), p.100812-100812, Article 100812
• Main Authors: Siargkas, Antonios, Tsakiridis, Ioannis, Pachi, Christina, Mamopoulos, Apostolos, Athanasiadis, Apostolos, Dagklis, Themistoklis
• Format: Article
• Language: English
• Subjects: Apgar; birthweight; cesarean; Female; Fetal Growth Retardation; Humans; Hypertension, Pregnancy-Induced; hypertensive disorders; Infant, Newborn; neonatal intensive care unit; outcome; Placenta; preeclampsia; Pregnancy; Pregnancy Outcome - epidemiology; Premature Birth - diagnosis; Premature Birth - epidemiology; Premature Birth - etiology; preterm delivery; small for gestational age; Stillbirth - epidemiology; Vasa Previa - diagnosis; Vasa Previa - epidemiology; velamentous cord insertion
• ISSN: 2589-9333; 2589-9333
• DOI: 10.1016/j.ajogmf.2022.100812

Velamentous cord insertion may be identified prenatally, but the clinical implications of this diagnosis remain controversial. This meta-analysis aimed to quantitatively summarize current data on the association of velamentous cord insertion and adverse perinatal outcomes. A systematic search was performed in MEDLINE, Scopus, and the Cochrane Library from inception until May 22, 2022 to identify eligible studies. Observational studies including singleton pregnancies with velamentous cord insertion, either prenatally or postnatally identified, and comparing them with those with central/eccentric cord insertion were considered eligible. The quality of the studies was assessed with the Newcastle–Ottawa scale and the risk of bias with the Quality In Prognosis Studies (QUIPS) tool. The main outcome was small-for-gestational-age neonates. Heterogeneity of the studies was evaluated using a Q test and an I2 index. Analyses were performed using a random-effects model, with outcome data reported as relative risk or mean difference with 95% confidence interval. In total, 9 cohort and 2 case–control studies, of which 4 had prenatal and 7 had postnatal velamentous cord insertion diagnosis, were included. The overall prevalence of velamentous cord insertion was estimated to be 1.4% among singleton pregnancies. Compared with the central/eccentric cord insertion control group, pregnancies with velamentous cord insertion were at higher risk of several adverse perinatal outcomes, namely small-for-gestational-age neonates (relative risk, 1.93; 95% confidence interval, 1.54–2.41), preeclampsia (relative risk, 1.85; 95% confidence interval, 1.01–3.39), pregnancy-induced hypertension (relative risk, 1.58; 95% confidence interval, 1.46–1.70), stillbirth (relative risk, 4.12; 95% confidence interval, 1.92–8.87), placental abruption (relative risk, 2.94; 95% confidence interval, 1.72–5.03), preterm delivery (relative risk, 2.14; 95% confidence interval, 1.73–2.65), emergency cesarean delivery (relative risk, 2.03; 95% confidence interval, 1.22–3.38), 1-minute Apgar score