Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Department of Epidemiology, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2021 Mar 17;21(1):211. doi: 10.1186/s12884-021-03703-x.
Umbilical cord may insert abnormally i.e. marginal insertion to a placenta which can cause different birth and perinatal complications. Despite the increased effort taken by different responsible bodies, the prevalence of birth and perinatal complications are still high, possibly due to anomalous cord insertion. So far, anomalous cord insertion lacks proper attention in different medical settings. Hence, the present study aims to assess the magnitude, risk factors, and adverse birth outcomes of marginal cord insertion among singleton births.
An institution-based cross-sectional study design was conducted. A systematic random sampling technique was used to select study participants. Data were collected by using a structured questionnaire and it was entered into epi-data version 3.1 then exported to SPSS version 20 for data cleansing and analysis. Bi-variable and multivariable logistic regressions were employed to identify risk factors and adverse outcomes associated with marginal cord insertions. Crude and adjusted odds ratio (P-value < 0.05) with a 95% confidence interval were calculated.
The magnitude of marginal cord insertion was 6.4% (95% CI = 4.4-8.8%) in singleton pregnancies. Independent risk factors for marginal cord insertion were advanced maternal age (AOR = 2.24, 95% CI: 1.35-11.08), primiparity (AOR = 1.98, 95% CI: 1.37-8.69), maternal chronic hypertension (AOR = 3.07, 95% CI: 1.66-9.76), previous cesarean delivery (AOR = 2.51, 95% CI: 1.43-10.21), and use of intrauterine contraceptive device before pregnancy (AOR = 2.22, 95% CI: 1.36-12.30). Pregnancies complicated by marginal cord insertion are at higher risk to develop low birth weight (AOR = 2.89, 95% CI: 1.23-6.80), preterm birth (AOR = 4.00, 95% CI: 1.44-11.14), and emergency cesarean delivery (AOR = 3.68, 95% CI: 1.03-13.81).
Marginal cord insertion is a mistreated potential risk for low birth weight, preterm birth, and emergency cesarean delivery. Routine screening of marginal cord insertion should be considered in pregnancies with advanced age, nulliparity, hypertensive disorder, history of cesarean section, and intrauterine contraceptive device usage before pregnancy.
脐带可能会异常插入胎盘，即边缘插入胎盘，这可能会导致不同的分娩和围产期并发症。尽管不同责任机构已经做出了更多努力，但分娩和围产期并发症的发生率仍然很高，这可能是由于脐带插入异常所致。到目前为止，不同的医疗环境中对异常脐带插入缺乏适当的关注。因此，本研究旨在评估单胎分娩中边缘脐带插入的发生率、危险因素和不良分娩结局。
采用基于机构的横断面研究设计。采用系统随机抽样技术选择研究对象。使用结构化问卷收集数据，并将其输入 epi-data 版本 3.1，然后导出到 SPSS 版本 20 进行数据清理和分析。采用双变量和多变量逻辑回归分析确定与边缘脐带插入相关的危险因素和不良结局。计算了粗比值比（P 值<0.05）和 95%置信区间。
在单胎妊娠中，边缘脐带插入的发生率为 6.4%（95%CI=4.4-8.8%）。边缘脐带插入的独立危险因素为高龄产妇（AOR=2.24，95%CI：1.35-11.08）、初产妇（AOR=1.98，95%CI：1.37-8.69）、产妇慢性高血压（AOR=3.07，95%CI：1.66-9.76）、既往剖宫产史（AOR=2.51，95%CI：1.43-10.21）和妊娠前使用宫内节育器（AOR=2.22，95%CI：1.36-12.30）。边缘脐带插入的妊娠更有可能发生低出生体重（AOR=2.89，95%CI：1.23-6.80）、早产（AOR=4.00，95%CI：1.44-11.14）和紧急剖宫产（AOR=3.68，95%CI：1.03-13.81）。
边缘脐带插入是低出生体重、早产和紧急剖宫产的潜在危险因素，未得到妥善处理。对于高龄产妇、初产妇、高血压疾病、剖宫产史和妊娠前使用宫内节育器的孕妇，应考虑常规筛查边缘脐带插入。
