Vaginal delivery in women with a low-lying placenta: a systematic review and meta-analysis

C.H.J.R. Jansen, Y.M. de Mooij, C.M. Blomaard, J.B. Derks, E. van Leeuwen, J. Limpens, E. Schuit, B.W. Mol, E. Pajkrt

Research output: Contribution to journalReview ArticleResearchpeer-review

6 Citations (Scopus)

Abstract

Background: Low-lying placentas are positioned close to the internal os of the cervix. The preferred way of delivery within this group is unclear. Objectives: To review the literature on the success of a vaginal delivery with a low-lying placenta. Search strategy: We searched OVID EMBASE and MEDLINE for studies on vaginal delivery with a low-lying placenta. Data collection and analyses: Data was extracted on successful vaginal delivery and emergency caesarean section due to haemorrhage. We distinguished between different distances between the cervical os and the placenta (internal os distance, IOD); 0–10, 11–20, and >20 mm. A meta-analysis of proportions was made for successful vaginal delivery and emergency caesarean section at every cut-off value. Maternal morbidity (i.e. antepartum blood loss, postpartum haemorrhage and blood transfusion) at different cut-off values was evaluated. Main results: Of the 999 articles retrieved, 10 articles met our inclusion criteria. A vaginal delivery was successful at an IOD of 0–10 mm in 43%, at an IOD of 11–20 mm in 85%, and at an IOD of >20 mm in 82%. A shorter IOD had a higher chance of antepartum haemorrhage, whereas a larger IOD needed postpartum blood transfusion more often. Postpartum haemorrhage did not depend on IOD. Conclusion: A low-lying placenta is not a contraindication for a trial of labour, and the morbidity in these women is not increased. However, women with a low-lying placenta have a higher chance of an emergency caesarean section compared with women with a placenta outside the lower uterine segment. Therefore, shared decision-making is mandatory in case of a trial of labour. Tweetable abstract: This systematic review demonstrates the possibility of a vaginal delivery in women with a low-lying placenta within 20 mm of the cervix.

Original languageEnglish
Pages (from-to) 1118-1126
Number of pages9
JournalBJOG: an International Journal of Obstetrics and Gynaecology
Volume126
Issue number9
DOIs
Publication statusPublished - Aug 2019

Keywords

  • Caesarean section
  • haemorrhage
  • low-lying placenta
  • vaginal delivery

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