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

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

21 Citations (Scopus)


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
Issue number9
Publication statusPublished - Aug 2019

Bibliographical note

Funding text
C.H.J.R.J Jansen: none. Y.M. de Mooij: none. C.M. Blo-maard: none. J.B. Derks: none. E. van Leeuwen: none. J. Limpens: none. E. Schuit: none. B.W. Mol is supported by an NHMRC Practitioner Fellowship (GNT1082548); B.W.M. reports consultancy for ObsEva, Merck Merck KGaA and Guerbet; E. Pajkrt: none. Completed disclosure of interest forms are available to view online as supporting information.


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


Dive into the research topics of 'Vaginal delivery in women with a low-lying placenta: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this