Ebbing Cathrine, Johnsen Synnøve L, Albrechtsen Susanne, Sunde Ingvild D, Vekseth Christina, Rasmussen Svein
Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Acta Obstet Gynecol Scand. 2017 Jan;96(1):78-85. doi: 10.1111/aogs.13035. Epub 2016 Nov 9.
Anomalous cord insertion is associated with increased risk of adverse maternal and perinatal outcome. Our aim was to study whether anomalous cord insertion is associated with prelabor rupture of membranes (PROM), preterm PROM (pPROM), long or short umbilical cord, and time trend of spontaneous preterm birth (SPTB) and anomalous cord insertion.
A population-based register study using data from the Medical Birth Register of Norway including all singleton births (gestational age >16 weeks and <45 weeks) during 1999-2013 (n = 860 465) to calculate odds ratios (ORs) for PROM, pPROM, SPTB, and cord length (>95th or <5th centile) according to the cord insertion site by logistic regression with adjustment for possible confounders. We also assessed time trends of SPTB and anomalous cord insertion.
Velamentous insertion of the cord was associated with an increased risk of PROM (OR 1.6, 95% CI 1.5-1.7), pPROM (OR 2.7, 95% CI 2.4-3.0), SPTB (OR 2.0, 95% CI 1.9-2.2), and a short cord (OR 1.7, 95% CI 1.5-1.8). Marginal insertion was to a lesser extent associated with these complications. Occurrences of SPTB and anomalous insertion declined. The decline in SPTB persisted after including an interaction term between anomalous insertion and time.
Velamentous and, to a lesser extent, marginal cord insertions were associated with increased risk of PROM, pPROM, SPTB, and short cord. This suggests a common pathogenesis behind altered function of the membranes, cord, and placenta. The decline in SPTB could not be explained by the reduction in the occurrence of anomalous cord insertion.
脐带附着异常与孕产妇及围产儿不良结局风险增加相关。我们的目的是研究脐带附着异常是否与胎膜早破（PROM）、早产胎膜早破（pPROM）、脐带过长或过短以及自发性早产（SPTB）和脐带附着异常的时间趋势有关。
一项基于人群的登记研究，使用挪威医疗出生登记处1999 - 2013年期间所有单胎分娩（孕周>16周且<45周）的数据（n = 860465），通过逻辑回归分析计算根据脐带附着部位发生PROM、pPROM、SPTB和脐带长度（>第95百分位数或<第5百分位数）的比值比（OR），并对可能的混杂因素进行调整。我们还评估了SPTB和脐带附着异常的时间趋势。
脐带帆状附着与PROM（OR 1.6，95%CI 1.5 - 1.7）、pPROM（OR 2.7，95%CI 2.4 - 3.0）、SPTB（OR 2.0，95%CI 1.9 - 2.2）以及脐带过短（OR 1.7，95%CI 1.5 - 1.8）的风险增加相关。边缘性附着与这些并发症的关联程度较小。SPTB和异常附着的发生率下降。在纳入异常附着与时间的交互项后，SPTB的下降趋势仍然存在。
脐带帆状附着以及程度较轻的边缘性附着与PROM、pPROM、SPTB和脐带过短的风险增加相关。这表明胎膜、脐带和胎盘功能改变背后存在共同的发病机制。SPTB的下降不能用脐带附着异常发生率的降低来解释。
