Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis
Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated wit...
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| description | Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes.
MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks' gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA.
This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37).
True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research. |
| doi_str_mv | 10.1371/journal.pone.0239630 |
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MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks' gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA.
This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37).
True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0239630</identifier><identifier>PMID: 32970750</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Abnormalities ; Apgar score ; Bias ; Biology and Life Sciences ; Complications ; Female ; Full text ; Gestation ; Health aspects ; Humans ; Knots ; Medicine and Health Sciences ; Meta-analysis ; Nuchal Cord - epidemiology ; Obstetrical research ; Physiological aspects ; Pregnancy ; Pregnancy complications ; Quality assessment ; Quality control ; Research and Analysis Methods ; Reviews ; Risk factors ; Search engines ; Stillbirth ; Stillbirth - epidemiology ; Systematic review ; Ultrasonic imaging ; Umbilical cord ; Umbilical Cord - abnormalities ; Umbilical Cord - pathology</subject><ispartof>PloS one, 2020-09, Vol.15 (9), p.e0239630</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Hayes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Hayes et al 2020 Hayes et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c622t-502a565adc1dfde72aba90199138c0bceac1328c5cc2a7ee3bf28c7655f8e17b3</citedby><cites>FETCH-LOGICAL-c622t-502a565adc1dfde72aba90199138c0bceac1328c5cc2a7ee3bf28c7655f8e17b3</cites><orcidid>0000-0002-4303-7845 ; 0000-0002-8807-0729</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7514048/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7514048/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32970750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Ryckman, Kelli K.</contributor><creatorcontrib>Hayes, Dexter J L</creatorcontrib><creatorcontrib>Warland, Jane</creatorcontrib><creatorcontrib>Parast, Mana M</creatorcontrib><creatorcontrib>Bendon, Robert W</creatorcontrib><creatorcontrib>Hasegawa, Junichi</creatorcontrib><creatorcontrib>Banks, Julia</creatorcontrib><creatorcontrib>Clapham, Laura</creatorcontrib><creatorcontrib>Heazell, Alexander E P</creatorcontrib><title>Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes.
MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks' gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA.
This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37).
True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research.</description><subject>Abnormalities</subject><subject>Apgar score</subject><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Complications</subject><subject>Female</subject><subject>Full text</subject><subject>Gestation</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Knots</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Nuchal Cord - epidemiology</subject><subject>Obstetrical research</subject><subject>Physiological aspects</subject><subject>Pregnancy</subject><subject>Pregnancy complications</subject><subject>Quality assessment</subject><subject>Quality control</subject><subject>Research and Analysis Methods</subject><subject>Reviews</subject><subject>Risk factors</subject><subject>Search engines</subject><subject>Stillbirth</subject><subject>Stillbirth - epidemiology</subject><subject>Systematic review</subject><subject>Ultrasonic imaging</subject><subject>Umbilical cord</subject><subject>Umbilical Cord - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hayes, Dexter J L</au><au>Warland, Jane</au><au>Parast, Mana M</au><au>Bendon, Robert W</au><au>Hasegawa, Junichi</au><au>Banks, Julia</au><au>Clapham, Laura</au><au>Heazell, Alexander E P</au><au>Ryckman, Kelli K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-09-24</date><risdate>2020</risdate><volume>15</volume><issue>9</issue><spage>e0239630</spage><pages>e0239630-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Current data on the role of the umbilical cord in pregnancy complications are conflicting; estimates of the proportion of stillbirths due to cord problems range from 3.4 to 26.7%. A systematic review and meta-analysis were undertaken to determine which umbilical cord abnormalities are associated with stillbirth and related adverse pregnancy outcomes.
MEDLINE, EMBASE, CINAHL and Google Scholar were searched from 1960 to present day. Reference lists of included studies and grey literature were also searched. Cohort, cross-sectional, or case-control studies of singleton pregnancies after 20 weeks' gestation that reported the frequency of umbilical cord characteristics or cord abnormalities and their relationship to stillbirth or other adverse outcomes were included. Quality of included studies was assessed using NIH quality assessment tools. Analyses were performed in STATA.
This review included 145 studies. Nuchal cords were present in 22% of births (95% CI 19, 25); multiple loops of cord were present in 4% (95% CI 3, 5) and true knots of the cord in 1% (95% CI 0, 1) of births. There was no evidence for an association between stillbirth and any nuchal cord (OR 1.11, 95% CI 0.62, 1.98). Comparing multiple loops of nuchal cord to single loops or no loop gave an OR of 2.36 (95% CI 0.99, 5.62). We were not able to look at the effect of tight or loose nuchal loops. The likelihood of stillbirth was significantly higher with a true cord knot (OR 4.65, 95% CI 2.09, 10.37).
True umbilical cord knots are associated with increased risk of stillbirth; the incidence of stillbirth is higher with multiple nuchal loops compared to single nuchal cords. No studies reported the combined effects of multiple umbilical cord abnormalities. Our analyses suggest specific avenues for future research.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32970750</pmid><doi>10.1371/journal.pone.0239630</doi><tpages>e0239630</tpages><orcidid>https://orcid.org/0000-0002-4303-7845</orcidid><orcidid>https://orcid.org/0000-0002-8807-0729</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Abnormalities Apgar score Bias Biology and Life Sciences Complications Female Full text Gestation Health aspects Humans Knots Medicine and Health Sciences Meta-analysis Nuchal Cord - epidemiology Obstetrical research Physiological aspects Pregnancy Pregnancy complications Quality assessment Quality control Research and Analysis Methods Reviews Risk factors Search engines Stillbirth Stillbirth - epidemiology Systematic review Ultrasonic imaging Umbilical cord Umbilical Cord - abnormalities Umbilical Cord - pathology |
| title | Umbilical cord characteristics and their association with adverse pregnancy outcomes: A systematic review and meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-06T09%3A07%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Umbilical%20cord%20characteristics%20and%20their%20association%20with%20adverse%20pregnancy%20outcomes:%20A%20systematic%20review%20and%20meta-analysis&rft.jtitle=PloS%20one&rft.au=Hayes,%20Dexter%20J%20L&rft.date=2020-09-24&rft.volume=15&rft.issue=9&rft.spage=e0239630&rft.pages=e0239630-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0239630&rft_dat=%3Cgale_plos_%3EA636415926%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2445951911&rft_id=info:pmid/32970750&rft_galeid=A636415926&rft_doaj_id=oai_doaj_org_article_c633e973628c4605acd7e583d814a682&rfr_iscdi=true |