Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis
ObjectiveTo investigate the risk of preterm birth in women with a placenta previa or a low-lying placenta for different cut-offs of gestational age and to evaluate preventive interventions.Search and methodsMEDLINE, EMBASE, CENTRAL, Web of Science, WHO-ICTRP and clinicaltrials.gov were searched unti...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.921220/full |
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| author | Charlotte H. J. R. Jansen Charlotte H. J. R. Jansen Charlotte E. van Dijk Charlotte E. van Dijk C. Emily Kleinrouweler Jacob J. Holzscherer Anouk C. Smits Jacqueline C. E. J. M. Limpens Brenda M. Kazemier Brenda M. Kazemier Elisabeth van Leeuwen Elisabeth van Leeuwen Eva Pajkrt Eva Pajkrt |
| author_facet | Charlotte H. J. R. Jansen Charlotte H. J. R. Jansen Charlotte E. van Dijk Charlotte E. van Dijk C. Emily Kleinrouweler Jacob J. Holzscherer Anouk C. Smits Jacqueline C. E. J. M. Limpens Brenda M. Kazemier Brenda M. Kazemier Elisabeth van Leeuwen Elisabeth van Leeuwen Eva Pajkrt Eva Pajkrt |
| author_sort | Charlotte H. J. R. Jansen |
| collection | DOAJ |
| description | ObjectiveTo investigate the risk of preterm birth in women with a placenta previa or a low-lying placenta for different cut-offs of gestational age and to evaluate preventive interventions.Search and methodsMEDLINE, EMBASE, CENTRAL, Web of Science, WHO-ICTRP and clinicaltrials.gov were searched until December 2021. Randomized controlled trials, cohort studies and case-control studies assessing preterm birth in women with placenta previa or low-lying placenta with a placental edge within 2 cm of the internal os in the second or third trimester were eligible for inclusion. Pooled proportions and odds ratios for the risk of preterm birth before 37, 34, 32 and 28 weeks of gestation were calculated. Additionally, the results of the evaluation of preventive interventions for preterm birth in these women are described.ResultsIn total, 34 studies were included, 24 reporting on preterm birth and 9 on preventive interventions. The pooled proportions were 46% (95% CI [39 – 53%]), 17% (95% CI [11 – 25%]), 10% (95% CI [7 – 13%]) and 2% (95% CI [1 – 3%]), regarding preterm birth <37, <34, <32 and <28 weeks in women with placenta previa. For low-lying placentas the risk of preterm birth was 30% (95% CI [19 – 43%]) and 1% (95% CI [0 – 6%]) before 37 and 34 weeks, respectively. Women with a placenta previa were more likely to have a preterm birth compared to women with a low-lying placenta or women without a placenta previa for all gestational ages. The studies about preventive interventions all showed potential prolongation of pregnancy with the use of intramuscular progesterone, intramuscular progesterone + cerclage or pessary.ConclusionsBoth women with a placenta previa and a low-lying placenta have an increased risk of preterm birth. This increased risk is consistent across all severities of preterm birth between 28-37 weeks of gestation. Women with placenta previa have a higher risk of preterm birth than women with a low-lying placenta have. Cervical cerclage, pessary and intramuscular progesterone all might have benefit for both women with placenta previa and low-lying placenta, but data in this population are lacking and inconsistent, so that solid conclusions about their effectiveness cannot be drawn.Systematic review registrationPROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42019123675. |
| first_indexed | 2024-04-11T18:13:21Z |
| format | Article |
| id | doaj.art-17fd7291198047ee9688373a76de6f6d |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-11T18:13:21Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-17fd7291198047ee9688373a76de6f6d2022-12-22T04:10:02ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-09-011310.3389/fendo.2022.921220921220Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysisCharlotte H. J. R. Jansen0Charlotte H. J. R. Jansen1Charlotte E. van Dijk2Charlotte E. van Dijk3C. Emily Kleinrouweler4Jacob J. Holzscherer5Anouk C. Smits6Jacqueline C. E. J. M. Limpens7Brenda M. Kazemier8Brenda M. Kazemier9Elisabeth van Leeuwen10Elisabeth van Leeuwen11Eva Pajkrt12Eva Pajkrt13Department of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsAmsterdam Reproduction and Development Research Institute, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsAmsterdam Reproduction and Development Research Institute, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsDepartment of Research Support–Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsAmsterdam Reproduction and Development Research Institute, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsAmsterdam Reproduction and Development Research Institute, Amsterdam, NetherlandsDepartment of Obstetrics and Gynecology, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, NetherlandsAmsterdam Reproduction and Development Research Institute, Amsterdam, NetherlandsObjectiveTo investigate the risk of preterm birth in women with a placenta previa or a low-lying placenta for different cut-offs of gestational age and to evaluate preventive interventions.Search and methodsMEDLINE, EMBASE, CENTRAL, Web of Science, WHO-ICTRP and clinicaltrials.gov were searched until December 2021. Randomized controlled trials, cohort studies and case-control studies assessing preterm birth in women with placenta previa or low-lying placenta with a placental edge within 2 cm of the internal os in the second or third trimester were eligible for inclusion. Pooled proportions and odds ratios for the risk of preterm birth before 37, 34, 32 and 28 weeks of gestation were calculated. Additionally, the results of the evaluation of preventive interventions for preterm birth in these women are described.ResultsIn total, 34 studies were included, 24 reporting on preterm birth and 9 on preventive interventions. The pooled proportions were 46% (95% CI [39 – 53%]), 17% (95% CI [11 – 25%]), 10% (95% CI [7 – 13%]) and 2% (95% CI [1 – 3%]), regarding preterm birth <37, <34, <32 and <28 weeks in women with placenta previa. For low-lying placentas the risk of preterm birth was 30% (95% CI [19 – 43%]) and 1% (95% CI [0 – 6%]) before 37 and 34 weeks, respectively. Women with a placenta previa were more likely to have a preterm birth compared to women with a low-lying placenta or women without a placenta previa for all gestational ages. The studies about preventive interventions all showed potential prolongation of pregnancy with the use of intramuscular progesterone, intramuscular progesterone + cerclage or pessary.ConclusionsBoth women with a placenta previa and a low-lying placenta have an increased risk of preterm birth. This increased risk is consistent across all severities of preterm birth between 28-37 weeks of gestation. Women with placenta previa have a higher risk of preterm birth than women with a low-lying placenta have. Cervical cerclage, pessary and intramuscular progesterone all might have benefit for both women with placenta previa and low-lying placenta, but data in this population are lacking and inconsistent, so that solid conclusions about their effectiveness cannot be drawn.Systematic review registrationPROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42019123675.https://www.frontiersin.org/articles/10.3389/fendo.2022.921220/fullplacenta previalow-lying placentapreterm birthcerclagepessaryprogesterone |
| spellingShingle | Charlotte H. J. R. Jansen Charlotte H. J. R. Jansen Charlotte E. van Dijk Charlotte E. van Dijk C. Emily Kleinrouweler Jacob J. Holzscherer Anouk C. Smits Jacqueline C. E. J. M. Limpens Brenda M. Kazemier Brenda M. Kazemier Elisabeth van Leeuwen Elisabeth van Leeuwen Eva Pajkrt Eva Pajkrt Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis Frontiers in Endocrinology placenta previa low-lying placenta preterm birth cerclage pessary progesterone |
| title | Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis |
| title_full | Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis |
| title_fullStr | Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis |
| title_full_unstemmed | Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis |
| title_short | Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis |
| title_sort | risk of preterm birth for placenta previa or low lying placenta and possible preventive interventions a systematic review and meta analysis |
| topic | placenta previa low-lying placenta preterm birth cerclage pessary progesterone |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.921220/full |
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