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Clinical Case Reports Nov 2019Vasa previa can occur even in cases without placental malposition and the precise diagnosis of vasa previa, and the course of the cord vessels contributes to a safe...
Vasa previa can occur even in cases without placental malposition and the precise diagnosis of vasa previa, and the course of the cord vessels contributes to a safe delivery. The color Doppler is a useful and easy-to-use device to confirm the presence of vasa previa.
PubMed: 31788261
DOI: 10.1002/ccr3.2432 -
Ultrasound in Obstetrics & Gynecology :... Sep 2020
Topics: Adult; Cesarean Section; Diagnosis, Differential; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Pulsatile Flow; Ultrasonography, Prenatal; Vasa Previa
PubMed: 31682304
DOI: 10.1002/uog.21910 -
Ultrasound in Obstetrics & Gynecology :... Apr 2020
Topics: Female; Humans; Placenta; Pregnancy; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 31115101
DOI: 10.1002/uog.20347 -
Revista Brasileira de Ginecologia E... May 2019Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the...
Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.
Topics: Adult; Cesarean Section; Diagnosis, Differential; Female; Fertilization in Vitro; Humans; Infant, Newborn; Male; Pregnancy; Prenatal Diagnosis; Ultrasonography, Prenatal; Vasa Previa
PubMed: 30939604
DOI: 10.1055/s-0039-1683354 -
Archives of Gynecology and Obstetrics Jun 2019Vasa praevia is a rare condition with high foetal mortality if not detected prenatally. There is limited evidence available to determine the ideal timing of delivery and...
PURPOSE
Vasa praevia is a rare condition with high foetal mortality if not detected prenatally. There is limited evidence available to determine the ideal timing of delivery and management recommendations. The aim of this study was to critically review our experience with vasa praevia, with a focus on diagnosis and management.
METHODS
In a retrospective analysis, all cases of vasa praevia identified in our department from January 2003 to December 2017 were included. All cases were diagnosed antenatally during sonographic inspection of the placenta, and individualized management for each patient was performed based on individual risk factors. 19 cases of vasa praevia were identified (15 singletons, four twins). 13 patients (79%) presented placental anomalies. In patients at high risk for preterm birth, caesarean delivery was performed between 34-35 weeks after early hospitalization and administration of corticosteroids, whereas in patients at low risk for preterm birth, caesarean section could be delayed to 35-37 weeks of gestation. Administration of corticosteroids was not obligatory in the latter cases.
RESULTS
There were two acute caesarean sections, due to premature abruption of the placenta and vaginal bleeding. There was no maternal or foetal/neonatal death. None of the neonates required blood transfusion. There is limited evidence available with which to determine the ideal timing of delivery.
CONCLUSION
However, our individualized, risk-adapted management, which attempts to delay the timing of caesarean section up to two weeks beyond the standard recommendation, seems feasible, with just two emergency caesarean sections and no case of foetal or maternal death.
Topics: Adult; Cesarean Section; Female; Humans; Pregnancy; Retrospective Studies; Risk; Vasa Previa
PubMed: 30915634
DOI: 10.1007/s00404-019-05125-9 -
Clinical Case Reports Feb 2019Vasa previa has been represented in many reports only by images of the placenta with velamentous cord insertion after delivery. Our image of the restored membranous...
Vasa previa has been represented in many reports only by images of the placenta with velamentous cord insertion after delivery. Our image of the restored membranous vessels with an intact membrane of the uterine lower segment is educational and should help readers to visualize vasa previa.
PubMed: 30847212
DOI: 10.1002/ccr3.1979 -
Ultrasound in Obstetrics & Gynecology :... Nov 2019
Review
Topics: Female; Fetoscopy; Gestational Age; Humans; Laser Therapy; Pregnancy; Vasa Previa
PubMed: 30801796
DOI: 10.1002/uog.20251 -
The New England Journal of Medicine Jan 2019
Topics: Adult; Female; Fetus; Humans; Placenta; Pregnancy; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 30650329
DOI: 10.1056/NEJMicm1808778 -
Ultrasound in Obstetrics & Gynecology :... May 2019
Topics: Adult; Diagnosis, Differential; Female; Humans; Image Interpretation, Computer-Assisted; Pregnancy; Spatio-Temporal Analysis; Ultrasonography, Prenatal; Vasa Previa
PubMed: 29808626
DOI: 10.1002/uog.19100 -
Ultrasound in Obstetrics & Gynecology :... Oct 2018To perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa in singleton pregnancies.
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.
Topics: Adult; Cost-Benefit Analysis; Decision Support Techniques; Female; Humans; Mass Screening; Placenta; Pregnancy; Reproducibility of Results; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 29786153
DOI: 10.1002/uog.19098