Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway.
PLoS One. 2013 Jul 30;8(7):e70380. doi: 10.1371/journal.pone.0070380. Print 2013.
To determine the prevalence of, and risk factors for anomalous insertions of the umbilical cord, and the risk for adverse outcomes of these pregnancies.
Population-based registry study.
Medical Birth Registry of Norway 1999-2009.
All births (gestational age >16 weeks to <45 weeks) in Norway (623,478 singletons and 11,263 pairs of twins).
Descriptive statistics and odds ratios (ORs) for risk factors and adverse outcomes based on logistic regressions adjusted for confounders.
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.
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).
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.
确定脐带异常插入的流行率和危险因素，以及这些妊娠的不良结局的风险。
基于人群的登记研究。
挪威医学出生登记处 1999-2009 年。
挪威所有妊娠（胎龄>16 周至<45 周）（623478 例单胎妊娠和 11263 例双胎妊娠）。
基于逻辑回归的描述性统计和优势比（ORs），对危险因素和不良结局进行调整，以控制混杂因素。
帆状或边缘脐带插入。胎盘早剥、前置胎盘、子痫前期、早产、剖宫产、低 Apgar 评分、转新生儿重症监护病房（NICU）、畸形、出生体重和围产儿死亡。
在单胎妊娠中，异常脐带插入的发生率为 7.8%（帆状 1.5%，边缘 6.3%），在双胎妊娠中为 16.9%（帆状 6%，边缘 10.9%）。这两种情况存在共同的危险因素；双胎妊娠和辅助生殖技术助孕妊娠是最重要的危险因素，而妊娠出血、高龄产妇、产妇慢性疾病、女性胎儿和既往异常脐带插入的妊娠是其他危险因素。帆状和边缘插入与不良结局的风险增加有关，如前置胎盘（OR=3.7，95%CI=3.1-4.6）和胎盘早剥（OR=2.6，95%CI=2.1-3.2）。子痫前期、早产和急性剖宫产的风险增加了一倍，Apgar 评分低、转新生儿重症监护病房、出生体重低和畸形的风险也增加了一倍。对于帆状插入，足月产的围产儿死亡风险增加了两倍，OR=3.3（95%CI=2.5-4.3）。
在单胎妊娠中，帆状和边缘脐带插入的发生率为 7.8%，在双胎妊娠中为 16.9%，边缘插入比帆状插入更为常见。这些情况与常见的危险因素和不良围产儿结局的风险增加有关；与边缘插入相比，帆状插入的风险更大。
