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Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis

OBJECTIVE: To 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 METHODS: MEDLINE, EMBASE, CENTRAL, Web of Science, WHO-ICTRP and clinicaltrials.gov were searched...

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Autores principales: Jansen, Charlotte H. J. R., van Dijk, Charlotte E., Kleinrouweler, C. Emily, Holzscherer, Jacob J., Smits, Anouk C., Limpens, Jacqueline C. E. J. M., Kazemier, Brenda M., van Leeuwen, Elisabeth, Pajkrt, Eva
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9478860/
https://www.ncbi.nlm.nih.gov/pubmed/36120450
http://dx.doi.org/10.3389/fendo.2022.921220
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author Jansen, Charlotte H. J. R.
van Dijk, Charlotte E.
Kleinrouweler, C. Emily
Holzscherer, Jacob J.
Smits, Anouk C.
Limpens, Jacqueline C. E. J. M.
Kazemier, Brenda M.
van Leeuwen, Elisabeth
Pajkrt, Eva
author_facet Jansen, Charlotte H. J. R.
van Dijk, Charlotte E.
Kleinrouweler, C. Emily
Holzscherer, Jacob J.
Smits, Anouk C.
Limpens, Jacqueline C. E. J. M.
Kazemier, Brenda M.
van Leeuwen, Elisabeth
Pajkrt, Eva
author_sort Jansen, Charlotte H. J. R.
collection PubMed
description OBJECTIVE: To 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 METHODS: MEDLINE, 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. RESULTS: In 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. CONCLUSIONS: Both 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 REGISTRATION: PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42019123675.
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spelling pubmed-94788602022-09-17 Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis Jansen, Charlotte H. J. R. van Dijk, Charlotte E. Kleinrouweler, C. Emily Holzscherer, Jacob J. Smits, Anouk C. Limpens, Jacqueline C. E. J. M. Kazemier, Brenda M. van Leeuwen, Elisabeth Pajkrt, Eva Front Endocrinol (Lausanne) Endocrinology OBJECTIVE: To 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 METHODS: MEDLINE, 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. RESULTS: In 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. CONCLUSIONS: Both 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 REGISTRATION: PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42019123675. Frontiers Media S.A. 2022-09-02 /pmc/articles/PMC9478860/ /pubmed/36120450 http://dx.doi.org/10.3389/fendo.2022.921220 Text en Copyright © 2022 Jansen, van Dijk, Kleinrouweler, Holzscherer, Smits, Limpens, Kazemier, van Leeuwen and Pajkrt https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Jansen, Charlotte H. J. R.
van Dijk, Charlotte E.
Kleinrouweler, C. Emily
Holzscherer, Jacob J.
Smits, Anouk C.
Limpens, Jacqueline C. E. J. M.
Kazemier, Brenda M.
van Leeuwen, Elisabeth
Pajkrt, Eva
Risk of preterm birth for placenta previa or low-lying placenta and possible preventive interventions: A systematic review and meta-analysis
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 Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9478860/
https://www.ncbi.nlm.nih.gov/pubmed/36120450
http://dx.doi.org/10.3389/fendo.2022.921220
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