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Ultrasound in Obstetrics & Gynecology :... Jun 2023
Topics: Pregnancy; Female; Humans; Vasa Previa; Fetoscopy; Laser Therapy; Ultrasonography, Prenatal
PubMed: 36609872
DOI: 10.1002/uog.26153 -
Biomedicines Dec 2022Vasa 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... (Review)
Review
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: () increased rate of succenturiate lobes (ART versus non-ART pregnancy; OR (odds ratio) 6.97, 95% confidence interval (CI) 2.45-19.78); () similar rate of abnormal placenta (cleavage-stage versus blastocyst embryo transfer); () 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.
PubMed: 36552018
DOI: 10.3390/biomedicines10123263 -
Medicine Dec 2022To investigate the relationship between abnormal umbilical cord insertion and birthweight discordance in monochorionic diamnionic (MCDA) twins. A total of 137 pairs of...
To investigate the relationship between abnormal umbilical cord insertion and birthweight discordance in monochorionic diamnionic (MCDA) twins. A total of 137 pairs of MCDAs were retrospectively analyzed who delivered and survived in Hangzhou Women's Hospital from January 2016 to December 2021. According to different insertion methods, they were divided into normal cord insertion group (n = 57), marginal cord insertion (MCI) group (n = 34) and velamentous cord insertion (VCI) group (n = 46). The correlation was analyzed between different insertion methods of umbilical cord and the discordant birth weight of MCDAs. The gestational age of delivery with velamentous cord insertion was significantly earlier than those with normal and marginal insertion (P < .05). There were significant differences in birthweight between large fetus (F1) and small fetus (F2) with different umbilical insertion methods (P < .05). The birthweight of F1 and F2 in normal insertion group was significantly higher than those in MCI and VCI group (P < .05). Logistic regression analysis showed that VCI was significantly associated with birth weight in F1/F2, birthweight discordance ≥ 20%, and birthweight discordance ≥ 25%, however MCI and VCI were not an independent factor for discordance in birthweight of MCDAs (P > .05). Umbilical cord insertion method can lead to inconsistency in birthweight of MCDA twins, however they were not an independent factor for discordance in birthweight.
Topics: Pregnancy; Female; Humans; Birth Weight; Retrospective Studies; Placenta; Umbilical Cord; Gestational Age; Vasa Previa; Twins, Monozygotic; Pregnancy, Twin
PubMed: 36550827
DOI: 10.1097/MD.0000000000032316 -
PloS One 2022The objective of this exploratory modelling study was to estimate the effects of second-trimester, ultrasound-based antenatal detection strategies for vasa praevia (VP)...
The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods.
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.
Topics: Pregnancy; Female; Humans; Vasa Previa; Umbilical Cord; Ultrasonography, Prenatal; Placenta; Prenatal Diagnosis
PubMed: 36538562
DOI: 10.1371/journal.pone.0279229 -
Journal of Environmental and Public... 2022The objective of this study is to evaluate feasibility and accuracy of transabdominal color Doppler ultrasound (TA-CDUS) and transvaginal color Doppler ultrasound...
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.
Topics: Female; Humans; Male; Predictive Value of Tests; Pregnancy; Pregnant Women; Retrospective Studies; Ultrasonography, Doppler, Color; Vasa Previa
PubMed: 36213044
DOI: 10.1155/2022/1685783 -
Ultrasound in Obstetrics & Gynecology :... Jan 2023
Topics: Female; Humans; Pregnancy; Vasa Previa; Ultrasonography, Prenatal; Cesarean Section
PubMed: 36178753
DOI: 10.1002/uog.26085 -
Journal of Medical Ultrasound 2023A 33-year-old woman, gravida 2 para 0, with a history of two previous miscarriages, underwent an investigation for recurrent miscarriage. After genetic counseling, the...
A 33-year-old woman, gravida 2 para 0, with a history of two previous miscarriages, underwent an investigation for recurrent miscarriage. After genetic counseling, the couple were submitted to the karyotype, which resulted in 45, X/46, XX mosaicism (mosaic Turner syndrome) in the wife result, while the husband chromosomal resulted in 46, XY (normal). After evaluating the options, the couple opted for fertilization. During prenatal follow-up, placenta and vasa previa were identified, considerably increasing the maternal-fetal mortality rate in this case. However, despite being a delicate and challenging case, the early diagnose was possible due to transvaginal ultrasound using color Doppler. Due to good care in obstetric follow-up, involving a multidisciplinary team, a therapeutic program and a successful outcome were possible. The patient underwent a cesarean section at 35 weeks of pregnancy, without complications, with a newborn in good general condition, despite the prematurity.
PubMed: 38025015
DOI: 10.4103/jmu.jmu_16_22 -
Biomedicines Jul 2022Abnormal cord insertion (ACI) is associated with adverse obstetric outcomes; however, the relationship between ACI and assisted reproductive technology (ART) has not... (Review)
Review
Abnormal cord insertion (ACI) is associated with adverse obstetric outcomes; however, the relationship between ACI and assisted reproductive technology (ART) has not been examined in a meta-analysis. This study examines the association between ACI and ART, and delivery outcomes of women with ACI. A systematic review was conducted, and 16 studies (1990-2021) met the inclusion criteria. In the unadjusted pooled analysis ( = 10), ART was correlated with a higher rate of velamentous cord insertion (VCI) (odds ratio (OR) 2.14, 95% confidence interval (CI) 1.64-2.79), marginal cord insertion ( = 6; OR 1.58, 95%CI 1.26-1.99), and vasa previa ( = 1; OR 10.96, 95%CI 2.94-40.89). Nevertheless, the VCI rate was similar among the different ART types (blastocyst cleavage-stage transfer and frozen fresh embryo transfer). Regarding the cesarean delivery (CD) rate, women with VCI were more likely to have elective ( = 3; OR 1.13, 95%CI 1.04-1.22) and emergent CD ( = 5; OR 1.93, 95%CI 1.82-2.03). In conclusion, ART may be correlated with an increased prevalence of ACI. However, most studies could not exclude confounding factors; thus, further studies are warranted to characterize ART as a risk factor for ACI. In women with ACI, elective and emergent CD rates are high.
PubMed: 35885027
DOI: 10.3390/biomedicines10071722 -
Ultrasound in Obstetrics & Gynecology :... Sep 2022
Topics: Female; Fetus; Humans; Pregnancy; Ultrasonography, Prenatal; Vasa Previa
PubMed: 35748883
DOI: 10.1002/uog.24982 -
International Journal of Surgery Case... Jun 2022Benckiser's hemorrhage is a serious obstetric emergency caused by rupture of one or more umbilical vessels of velamentous insertion, putting the fetus in distress and...
BACKGROUND
Benckiser's hemorrhage is a serious obstetric emergency caused by rupture of one or more umbilical vessels of velamentous insertion, putting the fetus in distress and leading to rapid fetal death through exsanguination in utero. It is an uncommon condition associated with a neonatal mortality rate of 75-100%. This hemorrhage of fetal origin happens most often when the membranes rupture, whether spontaneously or artificially. This is why prenatal diagnosis via ultrasound can only be beneficial and make it possible to schedule a prophylactic caesarean section before the onset of fetal death as well as other adverse perinatal outcomes.
CASE PRESENTATION
We hereby present an uncommon case of a 27-year-old female patient, with no antenatal check-ups, who presented to the emergency department for labor-like pain at a gestational age of 32 weeks. On examination, blood pressure was 140/89mmhg. Shortly after her hospitalization, the patient was experiencing steady vaginal bleeding as well as spontaneous rupture of the membranes. Retroplacental hematoma was suspected. It was then quickly decided to do an emergency caesarean section. It was only at the examination of the placenta that the diagnosis was corrected with the visualization of torn velamentous vessels, allowing immediate resuscitation of the newborn and admission in neonatal intensive care unit for blood transfusions.
CONCLUSIONS
Detailed prenatal ultrasonography screening for vasa previa in high risk pregnancies prevent the onset of complications related to their rupture. An elective caesarean section should be carried out prior to the onset of labor, most often at 35 weeks of amenorrhea, avoiding rupture of membranes and fetal exsanguination, while taking into consideration the impact of iatrogenic prematurity.
PubMed: 35561468
DOI: 10.1016/j.ijscr.2022.107128