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Jauniaux E, Ebbing C, Oyelese Y, Maymon R, Prefumo F, Bhide A. European association of perinatal medicine (EAPM) position statement: Screening, diagnosis and management of congenital anomalies of the umbilical cord. Eur J Obstet Gynecol Reprod Biol 2024; 298:61-65. [PMID: 38728843 DOI: 10.1016/j.ejogrb.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Congenital anomalies of the umbilical cord are associated with an increased risk of pregnancy and perinatal complications. Some anomalies of the cord have a higher prevalence than other fetal structural anomalies. The most common anomalies are the absence of an umbilical artery and velamentous insertion of the cord (with or without vasa previa). These anomalies, even when not associated with fetal structural defects, increase the risk of adverse perinatal outcome including, fetal growth restriction and stillbirth. In the absence of prenatal diagnosis, vasa previa is associated with the highest perinatal morbidity and mortality of all congenital anomalies of the umbilical cord. Most cases can be detected by ultrasound from the beginning of the second trimester and should be included in the routine mid-pregnancy ultrasound examination. Documentation should include cord insertion site, number of vessels in the cord, and if other pathologies have been detected. Pregnancies at increased risk of velamentous cord insertion should be screened for vasa previa using transvaginal ultrasound and colour Doppler imaging. If a velamentous cord insertion or isolated single umbilical artery is detected, individualised follow-up during pregnancy and tailored obstetric management are indicated.
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Affiliation(s)
- Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
| | - Cathrine Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway, Norway
| | - Yinka Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Rony Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Isreal
| | - Federico Prefumo
- Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Amar Bhide
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, St. George's Hospital, UK
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AIUM Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:E20-E32. [PMID: 38224490 DOI: 10.1002/jum.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
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Mohamad H, Yared G, Al Hassan J, Nakib H, El Hajjar C, Ghazal K. Vasa previa Type 3: Advocating for universal screening and investigation of risk factors: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241253747. [PMID: 38764916 PMCID: PMC11102669 DOI: 10.1177/2050313x241253747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/21/2024] Open
Abstract
Vasa previa is a critical obstetric condition marked by unprotected fetal vessels near the cervical os, traditionally divided into Types 1 and 2, based on its association with velamentous cord insertion and accessory placental lobes, respectively. The recent introduction of Type 3 vasa previa addresses atypical cases. We report a unique intrapartum diagnosis of Type 3 vasa previa in a 39-year-old at 38 weeks of gestation, identified during labor induction without prior risk indicators. Despite lacking traditional risk factors, advanced imaging and clinical vigilance led to a primary cesarean delivery, confirming the diagnosis through intraoperative findings of three aberrant vessels with marginal cord insertion. This case emphasizes the critical importance of considering vasa previa in prenatal and intrapartum care to prevent adverse outcomes, advocating for universal screening practices to identify this rare but significant condition.
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Affiliation(s)
- Hawraa Mohamad
- Obstetrics and Gynecology Resident at Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Georges Yared
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
| | - Jihad Al Hassan
- Department of Obstetrics and Gynecology, Al Zahraa Hospital University Medical Centre, Beirut, Lebanon
| | - Hamza Nakib
- The Lebanese American University, Beirut, Lebanon
| | - Charlotte El Hajjar
- Department of Obstetrics and Gynecology at Rafik Hariri University Hospital, Beirut, Lebanon
| | - Kariman Ghazal
- Department of Obstetrics and Gynecology at Rafik Hariri University Hospital, Beirut, Lebanon
- Department of Obstetrics and Gynecology at Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
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Ko H, Olisova K, Chang TY. Screening for vasa previa is a must in mid-pregnancy to save lives - incidence, methodology, and experiences from Taiwan. Taiwan J Obstet Gynecol 2024; 63:435-436. [PMID: 38802217 DOI: 10.1016/j.tjog.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Hsuan Ko
- Department of Fetal Medicine, Taiji Clinic, Taiwan
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Kim JJ, Bonhomme K, Oppenheimer LW, Gaudet L. Type III Vasa Previa Associated with Resolution of a Low-Lying Placenta: Case Report and Literature Review. AJP Rep 2024; 14:e136-e139. [PMID: 38736707 PMCID: PMC11087141 DOI: 10.1055/a-2315-7550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Vasa previa occurs when fetal vessels lie above the cervical os. A novel type of vasa previa, known as type III, is characterized by an abnormal branching of fetal vessels from the placenta in the absence of velamentous cord insertion (as seen in type I) or multilobed placenta (as seen in type II). Here, we present a case of a type III vasa previa after a resolution of a low-lying placenta. The presence of any known risk factors of vasa previa, including low-lying placenta, should prompt screening for vasa previa in the third trimester. Accurate and timely diagnosis of vasa previa will confer significant survival benefit for the neonate.
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Affiliation(s)
- Joanna J. Kim
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine Bonhomme
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Laura Gaudet
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
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Oyelese Y, Javinani A, Gudanowski B, Krispin E, Rebarber A, Akolekar R, Catanzarite V, D'Souza R, Bronsteen R, Odibo A, Scheier MA, Hasegawa J, Jauniaux E, Lees C, Srinivasan D, Daly-Jones E, Duncombe G, Melcer Y, Maymon R, Silver R, Prefumo F, Tachibana D, Henrich W, Cincotta R, Shainker SA, Ranzini AC, Roman AS, Chmait R, Hernandez-Andrade EA, Rolnik DL, Sepulveda W, Shamshirsaz AA. Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus. Am J Obstet Gynecol 2024:S0002-9378(24)00442-3. [PMID: 38494071 DOI: 10.1016/j.ajog.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/01/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies. OBJECTIVE This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique. STUDY DESIGN A 4-round focus group discussion and a 3-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a focus group discussion panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A 3-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa, which the experts were asked to rate on a 5-point Likert scale (from "strongly disagree"=1 to "strongly agree"=5). Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of ≤3 were deemed to have had no consensus and were excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and nonconsensus statements were then aggregated. RESULTS A total of 68 international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on 5 continents and have contributed to >80% of published cohort studies on vasa previa, as well as national and international society guidelines. Completion rates were 84%, 93%, and 91% for the first, second, and third rounds, respectively, and 71% completed all 3 rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including the following: (1) although there is no agreement on the distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2-cm distance; (2) all pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; (3) when a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at approximately 32 weeks to rule out vasa previa; (4) outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; (5) asymptomatic patients with vasa previa should be delivered by scheduled cesarean delivery between 35 and 37 weeks of gestation; and (6) there was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa. CONCLUSION Through focus group discussion and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical guidelines.
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Affiliation(s)
- Yinka Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA.
| | - Ali Javinani
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA
| | - Brittany Gudanowski
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Eyal Krispin
- Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Andrei Rebarber
- Division of Maternal Fetal Medicine, Mount Sinai West, New York, NY; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY; Carnegie Imaging for Women, PLLC, New York, NY
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, United Kingdom
| | - Val Catanzarite
- Maternal-Fetal Medicine, Rady Children's Specialists of San Diego, San Diego, CA
| | - Rohan D'Souza
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Richard Bronsteen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Corewell Health William Beaumont University Hospital, Royal Oak, MI
| | - Anthony Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Washington University School of Medicine, St. Louis, MO
| | | | - Junichi Hasegawa
- Department of Perinatal Development Pathophysiology, St. Marianna University Graduate School of Medicine, Kawasaki, Japan
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Christoph Lees
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Institute of Reproductive and Developmental Biology, Imperial College London, London, United Kingdom; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Deepa Srinivasan
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Elizabeth Daly-Jones
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gregory Duncombe
- Department of Obstetrics and Gynaecology, Logan Hospital, Metro South Health, Meadowbrook, Australia
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, Shamir Medical Center, Tzrifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Shamir Medical Center, Tzrifin, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Silver
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Federico Prefumo
- Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daisuke Tachibana
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Wolfgang Henrich
- Department of Obstetrics, Campus Virchow-Klinikum, Campus Charité Mitte, Universitätsmedizin Berlin, Berlin, Germany; Department of Obstetrics, Charité - University Medical Center, Berlin, Germany
| | - Robert Cincotta
- Department of Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Australia
| | - Scott A Shainker
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA
| | - Angela C Ranzini
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth System, Case Western Reserve University, Cleveland, OH
| | - Ashley S Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY
| | - Ramen Chmait
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Edgar A Hernandez-Andrade
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Waldo Sepulveda
- Fetal Imaging Unit, FETALMED Maternal-Fetal Diagnostic Center, Santiago, Chile
| | - Alireza A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Division of Fetal Medicine and Surgery, Department of Surgery, Boston Children's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Sciences, Harvard Medical School, Boston, MA.
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Bihun R, Trinidad MC, Packard AT. Impact of Universal Vasa Previa Screening With Color Doppler During the OB Ultrasound Anatomy Scan. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:479-487. [PMID: 38009660 DOI: 10.1002/jum.16378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/26/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Our institution introduced universal vasa previa (VP) screening utilizing transabdominal ultrasound with color Doppler for all pregnancies at the second trimester anatomy scan. Our study sought to describe the clinical impact of this intervention. METHODS Radiology records from the 12 months pre- and post-intervention were queried for "vasa previa." Records included for analysis were those with a first-time diagnosis or discussion of VP at the anatomy scan. Cases were categorized by outcome: (Group 1) True VP, with subgroups A, unresolved by time of delivery and B, resolved by delivery; (Group 2) False positives; (Group 3) Possible VP without definitive diagnosis; and (Group 4) VP ruled out, for example, "no features of VP." Group size was expressed as a percentage of total anatomy scans during pre- or post-intervention periods respectively. Absolute and relative percent change were calculated for each group. RESULTS In the pre-intervention period, 1 case (0.36% of total scans) was categorized in Group 1A, 1 case (0.36%) in Group 3, and 7 cases (2.53%) in Group 4. In the post-intervention period, 2 cases (0.30%) were in Group 1A, 4 cases (0.61%) in Group 1B, 2 cases (0.30%) in Group 2, 1 case (0.15%) in Group 3, and 7 cases (1.06%) in Group 4. There was a +153% relative change in true positives, from 0.36 to 0.91%. CONCLUSIONS Universal color Doppler screening may have increased detection (sensitivity) while simultaneously increasing false positives (decreased specificity). While decreasing sensitivity is not ideal, this is acceptable given the potential catastrophic outcome of a missed VP.
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Affiliation(s)
- Rebekah Bihun
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | | | - Ann T Packard
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Khalil A, Sotiriadis A, D'Antonio F, Da Silva Costa F, Odibo A, Prefumo F, Papageorghiou AT, Salomon LJ. ISUOG Practice Guidelines: performance of third-trimester obstetric ultrasound scan. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:131-147. [PMID: 38166001 DOI: 10.1002/uog.27538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/03/2023] [Indexed: 01/04/2024]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Faculty of Medicine, Thessaloniki, Greece
| | - F D'Antonio
- Centre for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital, and School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia
| | - A Odibo
- Obstetrics and Gynecology Department, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - F Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, UK; Nuffield Department for Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - L J Salomon
- URP FETUS 7328 and LUMIERE platform, Maternité, Obstétrique, Médecine, Chirurgie et Imagerie Foetales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
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Conyers S, Oyelese Y, Javinani A, Jamali M, Zargarzadeh N, Akolekar R, Hasegawa J, Melcer Y, Maymon R, Bronsteen R, Roman A, Shamshirsaz AA. Incidence and causes of perinatal death in prenatally diagnosed vasa previa: a systematic review and meta-analysis. Am J Obstet Gynecol 2024; 230:58-65. [PMID: 37321285 DOI: 10.1016/j.ajog.2023.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study aimed to estimate the perinatal mortality associated with prenatally diagnosed vasa previa and to determine what proportion of those perinatal deaths are directly attributable to vasa previa. DATA SOURCES The following databases have been searched from January 1, 1987, to January 1, 2023: PubMed, Scopus, Web of Science, and Embase. STUDY ELIGIBILITY CRITERIA Our study included all studies (cohort studies and case series or reports) that had patients in which a prenatal diagnosis of vasa previa was made. Case series or reports were excluded from the meta-analysis. All cases in which prenatal diagnosis was not made were excluded from the study. METHODS The programming language software R (version 4.2.2) was used to conduct the meta-analysis. The data were logit transformed and pooled using the fixed effects model. The between-study heterogeneity was reported by I2. The publication bias was evaluated using a funnel plot and the Peters regression test. The Newcastle-Ottawa scale was used to assess the risk of bias. RESULTS Overall, 113 studies with a cumulative sample size of 1297 pregnant individuals were included. This study included 25 cohort studies with 1167 pregnancies and 88 case series or reports with 130 pregnancies. Moreover, 13 perinatal deaths occurred among these pregnancies, consisting of 2 stillbirths and 11 neonatal deaths. Among the cohort studies, the overall perinatal mortality was 0.94% (95% confidence interval, 0.52-1.70; I2=0.0%). The pooled perinatal mortality attributed to vasa previa was 0.51% (95% confidence interval, 0.23-1.14; I2=0.0%). Stillbirth and neonatal death were reported in 0.20% (95% confidence interval, 0.05-0.80; I2=0.0%) and 0.77% (95% confidence interval, 0.40-1.48; I2=0.0%) of pregnancies, respectively. CONCLUSION Perinatal death is uncommon after a prenatal diagnosis of vasa previa. Approximately half of the cases of perinatal mortality are not directly attributable to vasa previa. This information will help in guiding physicians in counseling and will provide reassurance to pregnant individuals with a prenatal diagnosis of vasa previa.
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Affiliation(s)
- Steffany Conyers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yinka Oyelese
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Ali Javinani
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Marzieh Jamali
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Nikan Zargarzadeh
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ranjit Akolekar
- Medway Fetal and Maternal Medicine Centre, Medway NHS Foundation Trust, Gillingham, United Kingdom; Institute of Medical Sciences, Canterbury Christ Church University, Chatham, Kent, United Kingdom
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna School of Medicine, Kanagawa, Japan
| | - Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard Bronsteen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Corewell Health, Royal Oak, MI
| | - Ashley Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY
| | - Alireza A Shamshirsaz
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Saji S, Hasegawa J, Oyelese Y, Furuya N, Homma C, Nishimura Y, Nakamura M, Suzuki N. Individualized management of vasa previa and neonatal outcomes. J Obstet Gynaecol Res 2023; 49:2680-2685. [PMID: 37621145 DOI: 10.1111/jog.15775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To describe our individualized management protocol for women with an antenatal diagnosis of vasa previa (VP) and to report maternal and neonatal outcomes in patients managed according to our protocol. METHODS A retrospective study of prospectively collected data of antenatally diagnosed VP managed at our hospital between 2014 and 2021. Obstetric and neonatal outcomes were reviewed and analyzed. RESULTS Fourteen cases of antenatally diagnosed VP in 5150 total deliveries were analyzed (0.3%) Five cases (36%) of VP were diagnosed during the routine fetal morphological ultrasound screening, and nine cases (64%) were referred to our hospital due to perinatal complications. There were nine cases that required hospitalization (due to fetal growth restriction [FGR] [1], preterm labor [3], patients' request [5]). The other five were asymptomatic. Eight patients were delivered by scheduled cesarean section at around 36 weeks and only three neonates were admitted to NICU with transient tachypnea of newborn. However, six patients required CS before the scheduled dates because of other complications (preterm labor [3], abnormal cardiotocogram patterns [1], FGR [1] and twin pregnancy [1]). Four neonates born by CS before their scheduled dates were admitted to NICU. No cases required prolonged hospitalization and there were no serious neonatal complications. CONCLUSION Individualized management may lead to favorable outcomes with VP. Outpatient management may be considered in patients without risk factors. However, maternal hospitalization and earlier scheduled CS should be considered in symptomatic patients or those at risk for preterm delivery.
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Affiliation(s)
- Shota Saji
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yinka Oyelese
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, USA
| | - Natsumi Furuya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Chika Homma
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoko Nishimura
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masamitsu Nakamura
- Department of Obstetrics and Gynecology, Fujita Health University, Toyoake, Aichi, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
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Li P, Pan X, Yue C, Zheng Z, Liu H. Intrauterine death in vasa previa without hemorrhage: case reports. BMC Pregnancy Childbirth 2023; 23:707. [PMID: 37789298 PMCID: PMC10548614 DOI: 10.1186/s12884-023-06019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
Antepartum and intrapartum hemorrhage from vasa previa (VP) is one of the main causes of intrauterine fetal death (IUFD). Here, we present two cases with type I VP in which velamentous cord insertion below the fetal head and overlying the cervix were reported by prenatal ultrasound scanning, and IUFD occoured after 35 weeks with no signs of prenatal bleeding but with engaged fetal head at presentation. We hypothesized that the IUFD may attributed to the compression of the unprotected umbilical vessels by the engaged fetal head. Thus we suggest that VP with a velamentous cord insertion should be considered for earlier termination of the pregnancy to avoid the risk of non-hemorrhagic adverse fetal outcomes.
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Affiliation(s)
- Pin Li
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Xiuyu Pan
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Chaomin Yue
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Zheng Zheng
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Huishu Liu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China.
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Oyelese Y, Javinani A, Shamshirsaz AA. Vasa Previa. Obstet Gynecol 2023; 142:503-518. [PMID: 37590981 PMCID: PMC10424826 DOI: 10.1097/aog.0000000000005287] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/10/2023] [Accepted: 05/05/2023] [Indexed: 08/19/2023]
Abstract
Vasa previa refers to unprotected fetal vessels running through the membranes over the cervix. Until recently, this condition was associated with an exceedingly high perinatal mortality rate attributable to fetal exsanguination when the membranes ruptured. However, ultrasonography has made it possible to diagnose the condition prenatally, allowing cesarean delivery before labor or rupture of the membranes. Several recent studies have indicated excellent outcomes with prenatally diagnosed vasa previa. However, outcomes continue to be dismal when vasa previa is undiagnosed before labor. Risk factors for vasa previa include second-trimester placenta previa and low-lying placentas, velamentous cord insertion, placentas with accessory lobes, in vitro fertilization, and multifetal gestations. Recognition of individuals who are at risk and screening them will greatly decrease the mortality rate from this condition. Because of the relative rarity of vasa previa, there are no randomized controlled trials to guide management. Therefore, recommendations on the diagnosis and management of vasa previa are based largely on cohort studies and expert opinion. This Clinical Expert Series review addresses the epidemiology, pathophysiology, natural history, diagnosis and management of vasa previa, as well as innovative treatments for the condition.
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Affiliation(s)
- Yinka Oyelese
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School and Maternal Fetal Care Center at Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
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Jain V, Gagnon R. Guideline No. 439: Diagnosis and Management of Vasa Previa. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:506-518. [PMID: 37209787 DOI: 10.1016/j.jogc.2023.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE To summarize the current evidence and to make recommendations for diagnosis and classification of vasa previa and for management of women with this diagnosis. TARGET POPULATION Pregnant women with vasa previa or low-lying fetal vessels. OPTIONS To manage vasa previa in hospital or at home, and to perform a cesarean delivery preterm or at term, or to allow a trial of labour when a diagnosis of vasa previa or low-lying fetal vessels is suspected or confirmed. OUTCOMES Prolonged hospitalization, preterm birth, rate of cesarean delivery, and neonatal morbidity and mortality. BENEFITS, HARMS, AND COSTS Women with vasa previa or low-lying fetal vessels are at an increased risk of maternal and fetal or postnatal adverse outcomes. These outcomes include a potentially incorrect diagnosis, need for hospitalization, unnecessary restriction of activities, an early delivery, and an unnecessary cesarean delivery. Optimization of diagnostic and management protocols can improve maternal and fetal or postnatal outcomes. EVIDENCE Medline, Pubmed, Embase, and the Cochrane Library were searched from inception to March 2022, using medical subject headings (MeSH) and keywords related to pregnancy, vasa previa, low-lying fetal vessels, antepartum hemorrhage, short cervix, preterm labour, and cesarean delivery. This document presents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Obstetric care providers, including obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, and radiologists. TWEETABLE ABSTRACT Unprotected fetal vessels in placental membranes and cord that are close to the cervix, including vasa previa, need careful characterization by sonographic examination and evidence-based management to reduce risks to the baby and the mother during pregnancy and delivery. SUMMARY STATEMENTS RECOMMENDATIONS.
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Jain V, Gagnon R, Andrews J, Choo S, Codsi E, Coolen J, Guay A, Hutson J, Jain V, Ladhani NNN, Martin H, Niles K, Pylypjuk C, Quesnel G, Wong K. Directive clinique no 439: Diagnostic et prise en charge du vasa prævia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023:S1701-2163(23)00379-1. [PMID: 37209786 DOI: 10.1016/j.jogc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIF Résumer les données probantes actuelles et énoncer des recommandations pour le diagnostic et la classification du vasa prævia et pour la prise en charge des femmes ayant reçu ce diagnostic. POPULATION CIBLE Femmes enceintes présentant un vasa prævia ou des vaisseaux ombilicaux péricervicaux. OPTIONS En cas de diagnostic soupçonné ou confirmé de vasa prævia ou de vaisseaux ombilicaux péricervicaux, prendre en charge la patiente à l'hôpital ou à domicile, puis pratiquer une césarienne avant terme ou à terme ou entreprendre une épreuve de travail. RéSULTATS: Hospitalisation prolongée, accouchement prématuré, césarienne et morbidité et mortalité néonatales. BéNéFICES, RISQUES ET COûTS: Les femmes ayant un vasa prævia ou des vaisseaux ombilicaux péricervicaux présentent un risque accru d'issues défavorables maternelles, fœtales ou postnatales, à savoir un diagnostic potentiellement erroné, un besoin d'hospitalisation, une restriction inutile des activités, un accouchement précoce et une césarienne inutile. L'optimisation des protocoles de diagnostic et de prise en charge peut améliorer les issues maternelles, fœtales et postnatales. DONNéES PROBANTES: Des recherches ont été effectuées dans les bases de données Medline, PubMed, Embase et Cochrane Library, de leur création jusqu'à mars 2022, à partir de termes MeSH et de mots clés liés à la grossesse, au vasa prævia, aux vaisseaux prævia, à l'hémorragie ante partum, au col court, au travail prématuré et à la césarienne. Le présent document est un résumé des données probantes et non pas une revue méthodologique. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PROFESSIONNELS CONCERNéS: Fournisseurs de soins obstétricaux, y compris obstétriciens, médecins de famille, infirmières, sages-femmes, spécialistes en médecine fœto-maternelle et radiologistes. RéSUMé POUR TWITTER: En cas de cordon et de vaisseaux ombilicaux non protégés dans les membranes près du col (vasa prævia y compris), une caractérisation échographique et une prise en charge avisée s'imposent pour réduire les risques pour le bébé et la mère pendant la grossesse et l'accouchement.
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Current Evidence on Vasa Previa without Velamentous Cord Insertion or Placental Morphological Anomalies (Type III Vasa Previa): Systematic Review and Meta-Analysis. Biomedicines 2023; 11:biomedicines11010152. [PMID: 36672661 PMCID: PMC9856204 DOI: 10.3390/biomedicines11010152] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Vasa previa carries a high risk of severe fetal morbidity and mortality due to fetal hemorrhage caused by damage to unprotected fetal cord vessels upon membrane rupture. Vasa previa is generally classified into types I and II. However, some cases are difficult to classify, and some studies have proposed a type III classification. This study aimed to review the current evidence on type III vasa previa. A systematic literature search was conducted, and 11 articles (2011-2022) were included. A systematic review showed that type III vasa previa accounts for 5.7% of vasa previa cases. Thirteen women with type III vasa previa were examined at a patient-level analysis. The median age was 35 (interquartile range [IQR] 31.5-38) years, and approximately 45% were assisted reproductive technology (ART) pregnancies. The median gestational week of delivery was 36 (IQR 34-37) weeks; the antenatal detection rate was 84.6%, and no cases reported neonatal death. The characteristics and obstetric outcomes (rate of ART, antenatal diagnosis, emergent cesarean delivery, gestational age at delivery, and neonatal mortality) were compared between types I and III vasa previa, and all outcomes of interest were similar. The current evidence on type III vasa previa is scanty, and further studies are warranted.
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Oyelese Y, Lees CC, Jauniaux E. The case for screening for vasa previa: time to implement a life-saving strategy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:7-11. [PMID: 36178753 DOI: 10.1002/uog.26085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 05/27/2023]
Affiliation(s)
- Y Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - E Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Larcher L, Jauniaux E, Lenzi J, Ragnedda R, Morano D, Valeriani M, Michelli G, Farina A, Contro E. Ultrasound diagnosis of placental and umbilical cord anomalies in singleton pregnancies resulting from in-vitro fertilization. Placenta 2023; 131:58-64. [PMID: 36493624 DOI: 10.1016/j.placenta.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION placental anomalies can affect fetal and maternal outcome due to severe maternal hemorrhage potentially resulting in hysterectomy and cord accident including abruption that can determine fetal damage or death. The aims of our study are to determine if the rate of placental and umbilical cord anomalies are more common in IVF singleton pregnancies compared to spontaneous pregnancies; to evaluate the role of ultrasound in screening for these anomalies and to investigate if oocyte donor fertilization is an additional risk factor for the development of these anomalies. METHODS this was a prospective cohort study involving two tertiary centers. Patients with a singleton pregnancy conceived with IVF and patients presenting with a spontaneous conception were recruited between 1st May 2019 to 31st March 2021. A total of 634 pregnancies were enrolled in the study. All patients underwent similar antenatal care, which included ultrasound examinations at 11-14, 19-22 and 33-35 weeks. Ultrasound findings of placental and/or umbilical cord abnormalities were recorded using the same protocol for both groups and confirmed after birth. RESULTS IVF pregnancies had a significantly higher risk of low-lying placenta, placenta previa, bilobed placenta and velamentous cord insertion (VCI) compared with spontaneous pregnancies. In the heterologous subgroup there was a significant increased incidence of placenta accreta spectrum (PAS) disorders than in spontaneous pregnancies. All these anomalies were identified prenatally on ultrasound imaging and confirmed at birth. DISCUSSION IVF pregnancies in general and those resulting from donor oocyte in particular are at higher risk of placental and umbilical cord abnormalities compared to spontaneous pregnancies. These anomalies can be diagnosed accurately at the mid-trimester detailed fetal anomaly scan and our findings support the need for a targeted ultrasound screening of these anomalies in IVF pregnancies.
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Affiliation(s)
- L Larcher
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy.
| | - E Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, UK
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | - R Ragnedda
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - D Morano
- Department of Obstetrics and Gynecology S. Anna University Hospital, Cona, Ferrara, Italy
| | - M Valeriani
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - G Michelli
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - A Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
| | - E Contro
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS University Hospital of Bologna, Italy
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Ruban-Fell B, Attilakos G, Haskins-Coulter T, Hyde C, Kusel J, Mackie A, Rivero-Arias O, Thilaganathan B, Thomson N, Visintin C, Marshall J. The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods. PLoS One 2022; 17:e0279229. [PMID: 36538562 PMCID: PMC9767376 DOI: 10.1371/journal.pone.0279229] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
The objective of this exploratory modelling study was to estimate the effects of second-trimester, ultrasound-based antenatal detection strategies for vasa praevia (VP) in a hypothetical cohort of pregnant women. For this, a decision-analytic tree model was developed covering four discrete detection pathways/strategies: no screening; screening targeted at women undergoing in-vitro fertilisation (IVF); screening targeted at women with low-lying placentas (LLP); screening targeted at women with velamentous cord insertion (VCI) or a bilobed or succenturiate (BL/S) placenta. Main outcome measures were the number of referrals to transvaginal sonography (TVS), diagnosed and undiagnosed cases of VP, overdetected cases of VCI, and VP-associated perinatal mortality. The greatest number of referrals to TVS occurred in the LLP-based (2,083) and VCI-based screening (1,319) pathways. These two pathways also led to the highest proportions of pregnancies diagnosed with VP (VCI-based screening: 552 [78.9% of all pregnancies]; LLP-based: 371 [53.5%]) and the lowest proportions of VP leading to perinatal death (VCI-based screening: 100 [14.2%]; LLP-based: 196 [28.0%]). In contrast, the IVF-based pathway resulted in 66 TVS referrals, 50 VP diagnoses (7.1% of all VP pregnancies), and 368 (52.6%) VP-associated perinatal deaths which was comparable to the no screening pathway (380 [54.3%]). The VCI-based pathway resulted in the greatest detection of VCI (14,238 [99.1%]), followed by the IVF-based pathway (443 [3.1%]); no VCI detection occurred in the LLP-based or no screening pathways. In conclusion, the model results suggest that a targeted LLP-based approach could detect a substantial proportion of VP cases, while avoiding VCI overdetection and requiring minimal changes to current clinical practice. High-quality data is required to explore the clinical and cost-effectiveness of this and other detection strategies further. This is necessary to provide a robust basis for future discussion about routine screening for VP.
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Affiliation(s)
| | - George Attilakos
- Fetal Medicine Unit, University College London Hospital, London, United Kingdom
| | | | - Christopher Hyde
- Exeter Test Group, Institute of Health Research, College of Medicine and Health, University of Exeter, St. Luke’s Campus, Exeter, United Kingdom
| | | | - Anne Mackie
- National Screening Committee, Public Health England, London, United Kingdom
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George’s University Hospital NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George’s University of London, London, United Kingdom
| | - Nigel Thomson
- The Society and College of Radiographers, London, United Kingdom
| | | | - John Marshall
- UK National Screening Committee, London, United Kingdom
- * E-mail:
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Matsuzaki S, Ueda Y, Matsuzaki S, Kakuda M, Lee M, Takemoto Y, Hayashida H, Maeda M, Kakubari R, Hisa T, Mabuchi S, Kamiura S. The Characteristics and Obstetric Outcomes of Type II Vasa Previa: Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10123263. [PMID: 36552018 PMCID: PMC9776262 DOI: 10.3390/biomedicines10123263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Vasa previa is a rare fetal life-threatening obstetric disease classified into types I and II. This study aimed to examine the characteristics and obstetric outcomes of type II vasa previa. A systematic review was performed, and 20 studies (1998-2022) were identified. The results from six studies showed that type II vasa previa accounted for 21.3% of vasa previa cases. The characteristics and obstetric outcomes (rate of assisted reproductive technology (ART), antenatal diagnosis, emergent cesarean delivery, maternal transfusion, gestational age at delivery, and neonatal mortality) were compared between type I and II vasa previa, and all outcomes of interest were similar. The association between ART and abnormal placenta (bilobed placenta or succenturiate lobe) was examined in three studies, and the results were as follows: (i) increased rate of succenturiate lobes (ART versus non-ART pregnancy; OR (odds ratio) 6.97, 95% confidence interval (CI) 2.45-19.78); (ii) similar rate of abnormal placenta (cleavage-stage versus blastocyst embryo transfer); (iii) increased rate of abnormal placenta (frozen versus fresh embryo transfer; OR 2.97, 95%CI 1.10-7.96). Although the outcomes of type II vasa previa appear to be similar to those of type I vasa previa, the current evidence is insufficient for a robust conclusion.
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Affiliation(s)
- Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Correspondence: (S.M.); (Y.U.); Tel.: +81-6-6945-1181 (S.M.); +81-6-6879-3355 (Y.U.)
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Correspondence: (S.M.); (Y.U.); Tel.: +81-6-6945-1181 (S.M.); +81-6-6879-3355 (Y.U.)
| | - Satoko Matsuzaki
- Department of Obstetrics and Gynecology, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Mamoru Kakuda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Misooja Lee
- Department of Forensic Medicine, School of Medicine, Kindai University, Osaka 589-8511, Japan
| | - Yuki Takemoto
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Harue Hayashida
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Michihide Maeda
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Reisa Kakubari
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Tsuyoshi Hisa
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Seiji Mabuchi
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Shoji Kamiura
- Department of Gynecology, Osaka International Cancer Institute, Osaka 541-8567, Japan
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Liu Q, Zhang Q, Liu P. The Diagnostic Accuracy of Transabdominal and Transvaginal Color Doppler Ultrasound for Pregnant Women with Vasa Previa and Velamentous Cord Insertion. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:1685783. [PMID: 36213044 PMCID: PMC9536888 DOI: 10.1155/2022/1685783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022]
Abstract
Objective The objective of this study is to evaluate feasibility and accuracy of transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound (TV-CDUS) as screening methods for pregnant women with vasa previa (VP) and velamentous cord insertion (VCI). Methods A retrospective diagnostic accuracy study was performed on 5,434 pregnant women from 2018 to 2021, who underwent both TA-CDUS and TV-CDUS. Diagnostic performance of TA-CDUS and TV-CDUS was determined using specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and positive and negative likelihood ratios (LR+ and LR-), using the delivery information (gross examination) as the "Gold-standard". Patient records were reviewed for demographics and diagnosis. Results The combination of VP and VCI was diagnosed in 37/5434 (0.68%) women at delivery. The sensitivity, specificity, PPV, NPV, and overall test accuracy of TA-CDUS were 72.97%, 99.85%, 77.14%, 99.81%, and 99.67%, respectively, for diagnosing VP with VCI. The corresponding values for TV-CDUS were 89.19%, 99.87%, 82.50%, 99.93%, and 99.80%, respectively. Moreover, the sensitivity of combination of TA-CDUS and TA-CDUS in determining VP with VCI was 97.30%, specificity 99.98%, PPV 97.30%, NPV 99.98%, and accuracy 99.96%. No significant difference in the misdiagnosis and missed diagnosis was found between the examination by TA-CDUS and TV-CDUS. Conclusions Both TA-CDUS and TV-CDUS can be acceptable diagnostic tools for assessment of pregnant women with VP and VCI, with a better application of TV-CDUS with higher accuracy. The combination of TA-CDUS and TV-CDUS could provide an objective imaging basis for choosing clinical treatment strategies and predicting prognosis.
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Affiliation(s)
- Qing Liu
- Department of Ultrasound, Jingzhou Hospital Affiliated to Yangtze University, China
| | - Qiang Zhang
- Department of Ultrasound, Jingzhou Hospital Affiliated to Yangtze University, China
| | - Peiwu Liu
- Radiology Department, Jingzhou Hospital Affiliated to Yangtze University, China
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21
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto-Torres EE, Tirosh D, Jaiman S, Johnson A. Doppler evaluation of normal and abnormal placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:28-41. [PMID: 34806234 DOI: 10.1002/uog.24816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta. Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M F Bartal
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - D Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Jaiman
- Department of Obstetrics and Gynecology Wayne State University, Detroit, MI, USA
| | - A Johnson
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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22
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Degirmenci Y, Steetskamp J, Macchiella D, Hasenburg A, Hasenburg A. Vasa previa: A rare obstetric complication–A case series and a literature review. Clin Case Rep 2022; 10:e05608. [PMID: 35356178 PMCID: PMC8939036 DOI: 10.1002/ccr3.5608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yaman Degirmenci
- Department of Gynecology and Obstetrics University Medical Center Mainz Mainz Germany
| | - Joscha Steetskamp
- Department of Gynecology and Obstetrics University Medical Center Mainz Mainz Germany
| | - Doris Macchiella
- Department of Gynecology and Obstetrics University Medical Center Mainz Mainz Germany
| | | | - Annette Hasenburg
- Department of Gynecology and Obstetrics University Medical Center Mainz Mainz Germany
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23
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Sherer DM, Al-Haddad S, Cheng R, Dalloul M. Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology. Int J Womens Health 2021; 13:939-971. [PMID: 34703323 PMCID: PMC8541738 DOI: 10.2147/ijwh.s278747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022] Open
Abstract
The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton’s jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl’s anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.
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Affiliation(s)
- David M Sherer
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sara Al-Haddad
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Regina Cheng
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mudar Dalloul
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA
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24
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Sutera M, Garofalo A, Pilloni E, Parisi S, Alemanno MG, Menato G, Sciarrone A, Viora E. Vasa previa: when antenatal diagnosis can change fetal prognosis. J Perinat Med 2021; 49:915-922. [PMID: 33939903 DOI: 10.1515/jpm-2020-0559] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/14/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Evaluate ultrasound diagnostic accuracy, maternal-fetal characteristics and outcomes in case of vasa previa diagnosed antenatally, postnatally or with spontaneous resolution before delivery. METHODS Monocentric retrospective study enrolling women with antenatal or postnatal diagnosis of vasa previa at Sant'Anna Hospital in Turin from 2007 to 2018. Vasa previa were defined as fetal vessels that lay 2 cm within the uterine internal os using 2D and Color Doppler transvaginal ultrasound. Diagnosis was confirmed at delivery and on histopathological exam. Vasa previa with spontaneous resolutions were defined as fetal vessels that migrate >2 cm from uterine internal os during scheduled ultrasound follow-ups in pregnancy. RESULTS We enrolled 29 patients (incidence of 0.03%). Ultrasound antenatally diagnosed 25 vasa previa (five had a spontaneous resolution) while four were diagnosed postnatally, with an overall sensitivity of 96.2%, specificity of 100%, positive predictive value of 96.2%, and negative predictive value of 100%. Early gestational age at diagnosis is significally associate with spontaneously resolution (p 0.023; aOR 1.63; 95% IC 1.18-2.89). Nearly 93% of our patient had a risk factor for vasa previa: placenta previa at second trimester or low-lying placenta, bilobated placenta, succenturiate cotyledon, velametous cord insertion or assisted reproduction technologies. CONCLUSIONS Maternal and fetal outcomes in case of vasa previa antenatally diagnosed are significally improved. Our data support the evaluation of umbilical cord insertion during routine second trimester ultrasound and a targeted screening for vasa previa in women with risk factor: it allows identification of fetus at high risk, reducing fetal mortality in otherwise healthy newborns.
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Affiliation(s)
- Miriam Sutera
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Anna Garofalo
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Eleonora Pilloni
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Silvia Parisi
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maria Grazia Alemanno
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guido Menato
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Andrea Sciarrone
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Elsa Viora
- Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant'Anna Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
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25
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Gross A, Markota Ajd B, Specht C, Scheier M. Systematic screening for vasa previa at the 20-week anomaly scan. Acta Obstet Gynecol Scand 2021; 100:1694-1699. [PMID: 34077551 DOI: 10.1111/aogs.14205] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/06/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The presence of vasa previa carries a high risk for severe fetal morbidity and mortality due to fetal bleeding caused by injury to unprotected fetal vessels when rupture of membranes occurs. Previously, it has been shown that prenatal diagnosis significantly improves the outcome. However, systematic screening for vasa previa is not generally performed and clinical studies demonstrating the performance of systematic screening for vasa previa in routine clinical practice are rare. The objective of this study was to assess the performance of systematic screening for vasa previa by determining placental cord insertion at the 20-week anomaly scan. MATERIAL AND METHODS This is a retrospective study of 6038 pregnant women between 18+0 and 24+0 gestational weeks who were prospectively screened for vasa previa by depiction of the site of placental cord insertion at the 20-week anomaly scan. Pregnancies with marginal or velamentous cord insertion underwent vaginal sonography for examination for vasa previa. In cases with succenturiate or bilobed placentas, the bridging vessels were depicted, and vaginal sonography was performed if necessary. RESULTS There were 21 cases of vasa previa and all were diagnosed prenatally. In 18 cases, the cord insertion was marginal or velamentous. The remaining three cases had placental anomalies, which necessitated a detailed examination. All pregnancies with vasa previa were delivered at a mean of 35.2 (SD 1.8) gestational weeks by cesarean section. Among pregnancies affected by vasa previa, all fetuses survived. The median birthweight was 2390 g (range 1200-2990 g) and the mean umbilical artery pH 7.34 (SD 0.04). The median 5-min APGAR score was nine (range 7-10). None of the fetuses or neonates died or required blood transfusions. In all pregnancies of the whole cohort which were complicated by fetal or neonatal demise and in neonates with a 5-min APGAR score ≤5 and/or an umbilical artery pH ≤7.10, fetal blood loss was excluded as a cause of the poor obstetric outcome. CONCLUSIONS Screening for vasa previa is feasible and efficient, taking into account the site of placental cord insertion in pregnancies not affected by placenta previa and bilobed and succenturiate placenta.
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Affiliation(s)
- Anna Gross
- Ambulatorium für Fetalmedizin Feldkirch, Feldkirch, Austria.,Department of Obstetrics and Gynecology, Clinical Center, Klagenfurt, Austria
| | - Barbara Markota Ajd
- Ambulatorium für Fetalmedizin Feldkirch, Feldkirch, Austria.,Department of Obstetrics and Gynecology, Clinical Center, Klagenfurt, Austria
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26
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Horiuchi T, Sato H, Matsui K, Ikeda M, Morishita H, Hirose M. Vasa praevia with meandering fetal vessels despite placental and umbilical cord insertion on the same side of the uterine wall: A case report. Clin Case Rep 2021; 9:e04142. [PMID: 34026174 PMCID: PMC8135471 DOI: 10.1002/ccr3.4142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/27/2021] [Indexed: 11/23/2022] Open
Abstract
Vasa praevia with meandering fetal vessels is extremely rare, and it is difficult to diagnose this prenatally. When cesarean section is performed, a change in the site of uterine incision may be required for a safe delivery.
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Affiliation(s)
- Tatsuro Horiuchi
- Department of Obstetrics and GynecologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Hiroshi Sato
- Department of Obstetrics and GynecologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Katsunori Matsui
- Department of Obstetrics and GynecologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Makiko Ikeda
- Department of Obstetrics and GynecologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Hajime Morishita
- Department of Obstetrics and GynecologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
| | - Masaya Hirose
- Department of Obstetrics and GynecologyHyogo Prefectural Amagasaki General Medical CenterAmagasakiJapan
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27
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Liu N, Hu Q, Liao H, Wang X, Yu H. Vasa previa: Perinatal outcomes in singleton and multiple pregnancies. Biosci Trends 2021; 15:118-125. [PMID: 33746156 DOI: 10.5582/bst.2021.01052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vasa previa (VP) is a rare and life-threatening condition for the fetus. It is associated with increased perinatal mortality rates. The current study sought to retrospectively analyze the perinatal outcomes of VP in singleton and multiple pregnancies between January 1, 2013 and December 31, 2019 at a tertiary hospital in west China. One hundred and fifty-seven cases of VP were identified, including 131 singletons, 23 twins and 3 triplets. VP in 20 cases was diagnosed at delivery. There were 183 live births. Neonatal mortality was significantly higher in cases with no prenatal diagnosis (9.7% vs. 1.3%, p = 0.035). There was a significantly higher rate of NICU admission, premature infant and neonatal pneumonia in cases with prenatal diagnosis (p < 0.05). Among twin pregnancies with VP as a prenatal diagnosis, there were significantly earlier gestational age at admission (31.1 vs. 34.1 weeks, p = 0.000) and delivery age (33.4 vs. 35.3 weeks, p = 0.000) than those among singleton pregnancies. The neonatal mortality in twins with prenatal diagnosis was significantly higher than that in singletons (0% vs. 6.9%, p = 0.037). Early hospitalization of VP in the third trimester may be reasonable. The data suggest that the timing of elective delivery at 34-36 weeks in singletons and 32-34 weeks in twins may be suitable. It should be emphasized to make corresponding optimal delivery time according to individual differences for the women, especially in twin pregnancy.
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Affiliation(s)
- Na Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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28
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Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation. Obstet Gynecol 2021; 136:1211-1216. [PMID: 33156190 DOI: 10.1097/aog.0000000000004175] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The most common anomalies of implantation of the placenta and umbilical cord include placenta previa, placenta accreta spectrum, and vasa previa, and are associated with considerable perinatal and maternal morbidity and mortality. There is moderate quality evidence that prenatal diagnosis of these conditions improves perinatal outcomes and the performance of ultrasound imaging in diagnosing them is considered excellent. The epidemiology of placenta previa is well known, and it is standard clinical practice to assess placental location at the routine screening second-trimester detailed fetal anatomy ultrasound examination. In contrast, the prevalence of placenta accreta spectrum and vasa previa in the general population is more difficult to evaluate because detailed confirmatory histopathologic data are not available in most studies. The sensitivity and specificity of ultrasonography for the diagnosis of these anomalies is also difficult to assess. Recent epidemiologic studies show an increase in the incidence of placental and umbilical cord implantation anomalies, which may be the result of increased use of assisted reproductive technology and cesarean delivery. There is good evidence to support targeted standardized protocols for women at high risk and that screening and diagnosing placenta accreta spectrum and vasa previa should be integrated into obstetric ultrasound training programs.
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29
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Vasa praevia – ultrasonographic diagnosis and clinical management. GINECOLOGIA.RO 2021. [DOI: 10.26416/gine.33.3.2021.5310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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30
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Shipp TD, Poder L, Feldstein VA, Oliver ER, Promes SB, Strachowski LM, Sussman BL, Wang EY, Weber TM, Winter T, Glanc P. ACR Appropriateness Criteria® Second and Third Trimester Vaginal Bleeding. J Am Coll Radiol 2020; 17:S497-S504. [PMID: 33153560 DOI: 10.1016/j.jacr.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Vaginal bleeding can occur throughout pregnancy with varied etiologies. Although history and physical examination can identify many etiologies, imaging, in particular ultrasound (US), is the backbone of current medical practice. US pregnant uterus transabdominal, US pregnant uterus transvaginal, and US duplex Doppler velocimetry are usually appropriate for the evaluation of women with painless vaginal bleeding, those with painful vaginal bleeding, and also for those with second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa. US cervix transperineal may be appropriate for those with painless or painful vaginal bleeding but is usually not appropriate for second or third trimester vaginal bleeding with suspicion of or known placenta previa, low-lying placenta, or vasa previa. Because the outcome of pregnancies is unequivocally related to the specific etiology of the vaginal bleeding, knowledge of imaging results directly informs patient management to optimize the outcome for mother and fetus. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Thomas D Shipp
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Obstetricians and Gynecologists.
| | - Liina Poder
- Panel Chair, University of California San Francisco, San Francisco, California
| | | | - Edward R Oliver
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan B Promes
- Penn State Health, Hershey, Pennsylvania; American College of Emergency Physicians
| | | | - Betsy L Sussman
- The University of Vermont Medical Center, Burlington, Vermont
| | - Eileen Y Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; American College of Obstetricians and Gynecologists
| | | | - Tom Winter
- University of Utah, Salt Lake City, Utah
| | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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31
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La S, Melov SJ, Nayyar R. Are we over-diagnosing vasa praevia? The experience and lessons learned in a tertiary centre. Aust N Z J Obstet Gynaecol 2020; 61:217-222. [PMID: 33058152 DOI: 10.1111/ajo.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vasa praevia (VP) is a rare obstetric condition in which unprotected fetal vessels transverse the cervix, are vulnerable to rupture during labour and may result in rapid exsanguination of the fetus. Antenatal diagnosis of VP has resulted in excellent outcomes. However, there are little data available on the false positive rates for the antenatal diagnosis of VP. Improving accuracy of the diagnosis of VP can potentially improve outcomes and reduce unnecessary intervention. AIMS To assess our accuracy in the diagnosis of VP, examine our false positive diagnoses of VP and suggest strategies during antenatal ultrasound to aid in the antenatal diagnosis of VP. MATERIAL AND METHODS We conducted a retrospective descriptive study of women diagnosed with VP antenatally over 11 years at a single tertiary hospital and eligible patients were identified from obstetric databases. All medical records, including ultrasound reports, were reviewed and compared with the placental histological findings and both operative and midwifery documentation of the cord insertion. RESULTS Twenty-three women (25 babies) were diagnosed with VP and underwent a caesarean section delivery at a mean gestational age of 36 weeks. The false positive rate in our series was 17% (4/23). CONCLUSIONS Our study highlights the importance of postnatal confirmation of the diagnosis of VP and careful documentation of intraoperative findings of the placenta and cord insertion. We suggest strategies to aid in the accurate diagnosis of VP, thereby improving clinical decision-making and reducing unnecessary intervention.
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Affiliation(s)
- Stephanie La
- Department of Women's and Newborn Health, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sarah J Melov
- Discipline of Obstetrics Gynaecology and Neonatology, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
| | - Roshini Nayyar
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
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32
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Reis-de-Carvalho C, Afonso M, Carvalho RM. An Easy to Miss, but Preventable Tragedy: Vasa Previa. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2020; 42:508-510. [PMID: 32898915 PMCID: PMC10309220 DOI: 10.1055/s-0040-1713914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Catarina Reis-de-Carvalho
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Maria Afonso
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Rui Marques Carvalho
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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33
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Wiafe YA, Adu-Bredu TK, Appiah-Denkyira K, Senaya CM. Antenatal diagnosis of vasa previa: report of three cases in an African setting. Pan Afr Med J 2020; 37:24. [PMID: 33062126 PMCID: PMC7532851 DOI: 10.11604/pamj.2020.37.24.25663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/05/2022] Open
Abstract
Vasa previa is characterised by unprotected umbilical vessels that are crossing the internal cervical os or lying close to it. When vasa previa is not detected during antenatal period, the perinatal outcome could be grievous. Ultrasound is the modality of choice in detection of vasa previa. Despite the increasing availability of ultrasound in modern times, its use in diagnosing vasa previa still remain very low in Africa. We present the sonographic findings and perinatal outcomes of three cases of vasa previa which were detected antenatally within a period of nine months in an African setting.
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Affiliation(s)
- Yaw Amo Wiafe
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Theophilus Kofi Adu-Bredu
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Appiah-Denkyira
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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34
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Wax JR, Pinette MG. Imaging the Placental Cord Insertion: Just Do It. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:811-815. [PMID: 31674049 DOI: 10.1002/jum.15143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Joseph R Wax
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maine Medical Center, Portland, Maine, USA
| | - Michael G Pinette
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Maine Medical Center, Portland, Maine, USA
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35
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Jansen CHJR, Kastelein AW, Kleinrouweler CE, Van Leeuwen E, De Jong KH, Pajkrt E, Van Noorden CJF. Development of placental abnormalities in location and anatomy. Acta Obstet Gynecol Scand 2020; 99:983-993. [PMID: 32108320 PMCID: PMC7496588 DOI: 10.1111/aogs.13834] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/13/2020] [Accepted: 02/23/2020] [Indexed: 12/12/2022]
Abstract
Low‐lying placentas, placenta previa and abnormally invasive placentas are the most frequently occurring placental abnormalities in location and anatomy. These conditions can have serious consequences for mother and fetus mainly due to excessive blood loss before, during or after delivery. The incidence of such abnormalities is increasing, but treatment options and preventive strategies are limited. Therefore, it is crucial to understand the etiology of placental abnormalities in location and anatomy. Placental formation already starts at implantation and therefore disorders during implantation may cause these abnormalities. Understanding of the normal placental structure and development is essential to comprehend the etiology of placental abnormalities in location and anatomy, to diagnose the affected women and to guide future research for treatment and preventive strategies. We reviewed the literature on the structure and development of the normal placenta and the placental development resulting in low‐lying placentas, placenta previa and abnormally invasive placentas.
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Affiliation(s)
- Charlotte H J R Jansen
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arnoud W Kastelein
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - C Emily Kleinrouweler
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth Van Leeuwen
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Kees H De Jong
- Department of Medical Biology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J F Van Noorden
- Department of Medical Biology, Cancer Center Amsterdam, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Genetic Toxicology and Tumor Biology, National Institute of Biology, Ljubljana, Slovenia
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36
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Abstract
Importance Vasa previa represents an uncommon and life-threatening condition for the fetus. The prenatal identification of the condition may improve the outcome. Objective The aim of this study was to synthesize and compare published evidence of 4 national guidelines on diagnosis and management of vasa previa. Evidence Acquisition A descriptive review of 4 recently published national guidelines on vasa previa was conducted: Royal College of Obstetricians and Gynaecologists on "Vasa Praevia: Diagnosis and Management," Society for Maternal-Fetal Medicine on "Diagnosis and Management of Vasa Previa," Society of Obstetricians and Gynaecologists of Canada on "Guidelines for the Management of Vasa Previa," and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on "Vasa Praevia." These guidelines were compared regarding recommendations on diagnosis and management, while the quality of evidence was also reviewed based on each method of reporting. Results There were many similar recommendations in the compared guidelines regarding the diagnosis and management of vasa previa. Early prenatal diagnosis using ultrasound and color Doppler imaging, hospitalization or management as outpatients, and cesarean delivery in a tertiary center with experienced clinicians are the main recommendations. Conclusions Evidence-based guidelines may increase the awareness of the diagnosis and management of vasa previa among health care professionals and lead to more favorable perinatal outcomes.
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Vasa Praevia: A Nightmare to Good Outcome. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-019-00237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vasa previa: time to make a difference. Am J Obstet Gynecol 2019; 221:539-541. [PMID: 31787156 DOI: 10.1016/j.ajog.2019.08.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/09/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Vasa previa is a rare disorder of placentation associated with a high rate of perinatal morbidity and mortality when undetected before delivery. We have evaluated the recent evidence for prenatal diagnosis and management of vasa previa. RECENT FINDINGS Around 85% of cases of vasa previa have one or more identifiable risk factors including in-vitro fertilization, multiple gestations, bilobed, succenturiate or low-lying placentas, and velamentous cord insertion. The development of standardized prenatal targeted scanning protocols may improve perinatal outcomes. There is no clear consensus on the optimal surveillance strategy including the need for hospitalization, timing of corticosteroids administration and the value of transvaginal cervical length measurements. Outpatient management is possible if there is no evidence of cervical shortening on ultrasound and there are no symptoms of bleeding or uterine contractions. Recent national guidelines and expert reviews have recommended scheduled cesarean section of all asymptomatic women presenting with vasa previa between 34 and 36 weeks' gestation. SUMMARY Prenatal diagnosis of vasa previa is pivotal to prevent intrapartum fetal death. Although there is insufficient evidence to support the universal mid-gestation ultrasound screening for vasa previa, recent evidence indicates the need for standardized prenatal targeted screening protocols of pregnancies at high-risk of vasa previa.
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Humphries‐Hart F, Davies B, Bethune M, Saxton V. Detection of vasa praevia in the mid‐trimester ultrasound by Australian sonographers. SONOGRAPHY 2019. [DOI: 10.1002/sono.12191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ffion Humphries‐Hart
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Imaging for Women Ivanhoe Victoria Australia
| | - Braidy Davies
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Imaging for Women Ivanhoe Victoria Australia
| | - Michael Bethune
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
- Specialist Women's Ultrasound Box Hill Victoria Australia
| | - Virginia Saxton
- Medical Imaging DepartmentThe Mercy Hospital for Women Heidelberg Victoria Australia
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Javid N, Hyett JA, Homer CS. The experience of vasa praevia for Australian midwives: A qualitative study. Women Birth 2019; 32:185-192. [DOI: 10.1016/j.wombi.2018.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022]
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Javid N, Hyett JA, Walker SP, Sullivan EA, Homer CSE. A survey of opinion and practice regarding prenatal diagnosis of vasa previa among obstetricians from Australia and New Zealand. Int J Gynaecol Obstet 2019; 144:252-259. [PMID: 30575020 DOI: 10.1002/ijgo.12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/06/2018] [Accepted: 12/19/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To define current obstetric opinion and clinical practice regarding the prenatal diagnosis of vasa previa in Australia and New Zealand. METHODS A population-based cross-sectional survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted from April to May, 2016. Descriptive analysis was used to define factors influencing opinion and practice regarding definition of vasa previa, attributable risk factors, and the value of screening. RESULTS Overall, 453 respondents were included in the study. Two-thirds (304/453; 67.1%) defined vasa previa as exposed fetal vessel(s) running over or within 2 cm of the internal os. A higher proportion of ultrasound specialists (30/65; 46.2%) preferred a broader definition as compared with generalists (115/388; 29.6%; P<0.001). Overall, Fellows were supportive (342/430; 79.5%) of both reporting ultrasound-based risk factors at the 20-week anomaly scan and targeted screening (298/430; 69.3%). Only 77/453 (17.0%) respondents recognized all five "known" risk factors for vasa previa. CONCLUSIONS There was a lack of consensus regarding the definition and diagnosis process for vasa previa. There was also a knowledge gap in risk factors for vasa previa that would inform a targeted screening policy. Nevertheless, support for targeted screening was strong from obstetricians who responded.
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Affiliation(s)
- Nasrin Javid
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jonathan A Hyett
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Mercy Hospital for Women, University of Melbourne, Melbourne, Vic., Australia
| | | | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:E13-E24. [PMID: 30308091 DOI: 10.1002/jum.14831] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Javid N, Hyett JA, Homer CS. Providing quality care for women with vasa praevia: Challenges and barriers faced by Australian midwives. Midwifery 2018; 68:91-98. [PMID: 30396003 DOI: 10.1016/j.midw.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To explore the barriers to providing quality maternity care for women with vasa praevia as identified by Australian midwives. DESIGN A qualitative descriptive study using semi-structured in-depth telephone interviews. SETTING Australian maternity system. METHODS Midwives were recruited from across Australia. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. PARTICIPANTS Twenty midwives from five Australian states practising in 15 different public or private hospitals who had cared for at least one woman with vasa praevia during 2010-2016 were interviewed. More than half of the participants held senior positions. Twelve were involved in a neonatal death or 'near-miss' due to vasa praevia. FINDINGS Two categories and five themes were identified in relation to barriers to the provision of quality care. Practitioner-level barriers included two themes: identifying lack of midwifery education and lack of knowledge. System-level barriers included lack of a local policy to guide practice, limited information for women, and paucity of research about vasa praevia. CONCLUSION Midwives experienced a number of barriers in caring for women with vasa praevia. Offering more comprehensive pre-registration and continuing professional education to midwives, developing local protocols, and providing clear written information for women may improve the provision of quality care. IMPLICATIONS FOR PRACTICE Midwives have a critical role in caring for and supporting women with vasa praevia. Improving midwives' knowledge with contemporary evidence and clinical guidelines could enable them to deliver safer maternity care and improve a women's journey through this potentially catastrophic condition.
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Affiliation(s)
- Nasrin Javid
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Building 10, Jones Street, Broadway, Sydney, NSW 2007, Australia.
| | - Jon A Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Sydney, 50 Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Caroline Se Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Building 10, Jones Street, Broadway, Sydney, NSW 2007, Australia.
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Sinkey RG, Odibo AO. Vasa previa screening strategies: decision and cost-effectiveness analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:522-529. [PMID: 29786153 DOI: 10.1002/uog.19098] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa in singleton pregnancies. METHODS A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios that were carried out at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening only pregnancies conceived by in-vitro fertilization (IVF) and universal screening. Ultrasound-indicated screening was defined as performing transvaginal ultrasound at the time of the routine anatomy ultrasound scan in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality-adjusted life year (QALY) in US$. The analysis was performed from a healthcare system perspective with a willingness-to-pay threshold of $100 000 per QALY selected. One-way and multivariate sensitivity analysis (Monte-Carlo simulation) was performed. RESULTS This decision-analytic model demonstrated that screening pregnancies conceived by IVF was the most cost-effective strategy, with an incremental cost effectiveness ratio (ICER) of $29186.50/QALY. Ultrasound-indicated screening was the second most cost-effective, with an ICER of $56096.77/QALY. These data were robust to all one-way and multivariate sensitivity analyses performed. CONCLUSIONS Within the baseline assumptions, transvaginal ultrasound screening for vasa previa appears to be most cost-effective when performed among IVF pregnancies. However, both IVF and ultrasound-indicated screening strategies fall within contemporary willingness-to-pay thresholds, suggesting that both strategies may be appropriate to apply in clinical practice. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R G Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A O Odibo
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL, USA
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Jauniaux ERM, Alfirevic Z, Bhide AG, Burton GJ, Collins SL, Silver R. Vasa Praevia: Diagnosis and Management. BJOG 2018; 126:e49-e61. [DOI: 10.1111/1471-0528.15307] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1587-1596. [PMID: 30133848 DOI: 10.1002/jum.14677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Kulkarni A, Powel J, Aziz M, Shah L, Lashley S, Benito C, Oyelese Y. Vasa Previa: Prenatal Diagnosis and Outcomes: Thirty-five Cases From a Single Maternal-Fetal Medicine Practice. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1017-1024. [PMID: 29048133 DOI: 10.1002/jum.14452] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/27/2017] [Accepted: 07/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa. METHODS A retrospective descriptive study of all cases of vasa previa from a single maternal-fetal medicine service between 2009 and 2017 was performed. Ultrasound findings and obstetric and neonatal outcomes were reviewed and analyzed. RESULTS Thirty-five cases of vasa previa were identified. Most cases (33 of 35 [94.3%]) were diagnosed antenatally. All 33 cases that followed our screening protocol were diagnosed antenatally and had favorable outcomes. Two cases that did not follow our protocol were not diagnosed antenatally and were delivered emergently. The mean gestational age ± SD at delivery of antenatally diagnosed cases was 34.9 ± 1.69 weeks. All neonates survived. CONCLUSIONS Routine ultrasound screening for vasa previa using American Institute of Ultrasound in Medicine criteria will almost universally lead to good outcomes and prevent perinatal mortality.
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Affiliation(s)
- Ankita Kulkarni
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Jennifer Powel
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Michael Aziz
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Leena Shah
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Susan Lashley
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Carlos Benito
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
| | - Yinka Oyelese
- Atlantic Maternal-Fetal Medicine, Morristown Medical Center, Morristown, New Jersey, USA
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Melcer Y, Jauniaux E, Maymon S, Tsviban A, Pekar-Zlotin M, Betser M, Maymon R. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol 2018; 218:443.e1-443.e8. [PMID: 29353034 DOI: 10.1016/j.ajog.2018.01.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/31/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Placenta accreta spectrum and vasa previa (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes. OBJECTIVE The objective of the study was to compare perinatal outcome in women with placenta accreta spectrum or vasa previa before and after implementation of targeted scanning protocols. STUDY DESIGN This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004-1012 vs 2013-2016 for placenta accreta spectrum and 1988-2007 vs 2008-2016 for vasa previa). Clinical reports of women diagnosed with placenta accreta spectrum and vasa previa during the study periods were reviewed and outcomes were compared. RESULTS In total, there were 97 cases of placenta accreta spectrum and 51 cases with vasa previa, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the scanning protocols (28 of 65 cases [43.1%] vs 31 of 32 cases [96.9%], P < .001, for placenta accreta spectrum and 9 of 18 cases [50%] vs 29 of 33 cases [87.9%], 87.9%, P < .01 for vasa previa). The perinatal outcome improved also significantly in both cohorts after implementation of the protocols. In the placenta accreta spectrum cohort, the estimated blood loss and the postoperative hospitalization stay decreased between periods (1520 ± 845 vs 1168 ± 707 mL, P < .01, and 10.9 ± 14.1 vs 5.7 ± 2.2 days, P < .05, respectively). In the vasa previa cohort, the number of 5 minute Apgar score ≤5 and umbilical cord pH <7 decreased between periods (5 of 18 cases [27.8%] vs 1 of 33 cases [3%]; P < .05, and 4 of 18 cases [22.2%] vs 1 of 33 cases [3%], P < .05, respectively). CONCLUSION The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for placenta accreta spectrum and vasa previa was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and use of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels.
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Coleman G, Venables H. Is ultrasound screening for vasa praevia clinically justified and a financially viable screening test? A literature review. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:6-15. [PMID: 29456577 DOI: 10.1177/1742271x17747139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022]
Abstract
Vasa praevia is an obstetric complication currently not screened for within the United Kingdom, which if undetected prenatally can lead to fetal death when the membranes rupture. Internationally, guidelines are available providing guidance on the best screening policy and management pathways. However, the UK National Screening Committee and Royal College of Obstetricians and Gynaecologists do not support screening due to a lack of evidence. Recent studies explore the ability of ultrasound to detect vasa praevia prenatally in both the general and high-risk populations. Whilst there is no consensus on the 'best' screening strategy, the majority of authors note that targeted screening of the high-risk population is the most achievable and cost-effective strategy. Although not infallible, a standard screening protocol could identify the majority of cases in the high-risk group. Introduction of a screening strategy would affect training needs of professionals within the UK and would have implications on the need to produce guidelines on management and quality assurance. Further research is also needed to define a relevant high-risk population and explore how this would impact on service provision. This review explores the current evidence base for systematic screening and the implications for service.
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Affiliation(s)
- Gillian Coleman
- 1College of Health and Social Care, University of Derby, Derby, UK.,Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Heather Venables
- 1College of Health and Social Care, University of Derby, Derby, UK
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