Amniotomy and umbilical cord prolapse: a systematic review

Abstract

OBJECTIVE

To assess the risk of umbilical cord prolapse from amniotomy in pregnancy.

METHODS

We systematically searched through three electronic databases including Pubmed, Scopus and The Cochrane database of systematic review without any language restriction as well as we also checked and hand searched for additional studies from references of the included studies to assess the risk of umbilical cord prolapse from amniotomy in pregnancy.

RESULTS

We included one cohort study and three case-control studies involving 122,332 pregnant women, 650 with umbilical cord prolapse and 121,876 controls. All of the included studies had high quality. The meta-analysis showed no significant association between amniotomy and umbilical cord prolapse (odds ratio (OR), 1.03; 95% CI [0.36 to 2.93]; chi-square=57.00, I2=95%). For other factors, multiparous was a risk factor for umbilical cord prolapse (OR, 2.26; 95% CI [1.81 to 2.83]; chi-square=3.14, I2=36%) as both malpresentation, breech presentation was a risk factor of umbilical cord prolapse (odds ratio, 3.75; 95% CI [2.85 to 4.94]; chi-square=2.56; I2=22%) and transverse presentation was significantly related to umbilical cord prolapse but high heterogeneity (odds ratio, 8.20; 95% CI [1.83 to 36.72]; chi-square=6.72; I2=70%).

CONCLUSION

The association of amniotomy and umbilical cord prolapse was not definite according to high heterogeneity. More evidence is still required.