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Acta Obstetricia Et Gynecologica... Jul 2024Vasa previa (VP), defined as unprotected fetal vessels traversing the membranes over the cervix, is associated with a high perinatal mortality when undiagnosed...
INTRODUCTION
Vasa previa (VP), defined as unprotected fetal vessels traversing the membranes over the cervix, is associated with a high perinatal mortality when undiagnosed prenatally. Conversely, prenatal diagnosis with ultrasound and cesarean delivery before the membranes rupture is associated with excellent outcomes. However, controversy exists regarding screening for VP. In the UK, routine screening for VP is not recommended. The objective of this study was to report the incidence of VP and our experience in the detection of VP with a universal screening protocol at the time of the second-trimester fetal anomaly scan with third-trimester confirmation in an unselected population of pregnancies.
MATERIAL AND METHODS
We performed a single-center historical cohort study of all pregnant women who underwent routine second-trimester anomaly screening scans at West Middlesex University Hospital, London, UK, between 2012 and 2016. Over 5 years, every patient undergoing routine anomaly screening was evaluated for VP using a systematic protocol during their 20-week anomaly scan. Suspected cases of VP were rescanned in the third trimester by specialist sonographers with an interest in VP. The primary outcomes were the incidence and detection of VP.
RESULTS
During the study period, 24 690 anatomy scans were performed. A total of 64 patients were identified as having potential VP at the second-trimester anomaly screening scan, of which 19 were confirmed by the specialist sonographer in the third trimester and at delivery. The screen positive rate was 0.26% (95% confidence interval [CI] 0.20%-0.32%). VP at birth was found in 19/24690 births (1:1299 [95% CI: 1:832-1:2030] births). Universal screening for VP using our protocol had a sensitivity of 100% and a specificity of 99.78% (95% CI: 99.72%-99.84%). The false-positive rate of the second-trimester screen was 0.18% (95% CI: 0.13-0.24). There were no false positives or false negatives at delivery. Of the 19 patients with confirmed VP, 17 had scheduled cesarean deliveries, and two required emergency deliveries due to antepartum hemorrhage. One baby died, giving a perinatal mortality of 5%.
CONCLUSIONS
VP complicates approximately 1:1300 pregnancies. Routine screening for VP yielded a 100% detection rate. We suggest the inclusion of structured VP assessment in standard fetal anomaly screening programs.
Topics: Humans; Female; Pregnancy; Vasa Previa; Ultrasonography, Prenatal; Adult; Pregnancy Trimester, Second; Cohort Studies; Incidence; Pregnancy Trimester, Third; United Kingdom
PubMed: 38594913
DOI: 10.1111/aogs.14839 -
Cureus Mar 2024Vasa previa is a rare but potentially life-threatening condition to the fetus. Timely antenatal diagnosis and delivery by cesarean section (CS) can lead to a favorable...
Vasa previa is a rare but potentially life-threatening condition to the fetus. Timely antenatal diagnosis and delivery by cesarean section (CS) can lead to a favorable outcome. Here, we report a case of recurrent pregnancy loss (G3A2) with vasa previa, which was diagnosed prenatally by ultrasound. She was admitted at her 31st week with bleeding per vaginum (PV) provisionally diagnosed as antepartum hemorrhage (APH) and managed conservatively as placenta previa. Follow-up ultrasonography (USG) revealed vasa previa at 33 weeks. The fetus was delivered by lower segment cesarean section (LSCS) after careful separation of the membranes and avoiding damage to the vessels as there was velamentous insertion of cord with the lower margin of the placenta in the lower segment. The baby was cared for in the neonatal intensive care unit due to prematurity and discharged after six days. This case report highlights the importance of prenatal ultrasound in diagnosing vasa previa and planning an elective cesarean section with caution intraoperatively for the safe delivery of the baby.
PubMed: 38576689
DOI: 10.7759/cureus.55578 -
Radiographics : a Review Publication of... Apr 2024Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both...
Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Placenta; Cesarean Section; Puerperal Disorders; Hematoma
PubMed: 38547034
DOI: 10.1148/rg.230164 -
American Journal of Obstetrics and... Mar 2024There 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.
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.
PubMed: 38494071
DOI: 10.1016/j.ajog.2024.03.013 -
Australasian Journal of Ultrasound in... Feb 2024The routine mid-trimester fetal anatomy ultrasound (FAS) is offered to every pregnant woman and remains critical in the detection of structural fetal anomalies. Our...
INTRODUCTION/PURPOSE
The routine mid-trimester fetal anatomy ultrasound (FAS) is offered to every pregnant woman and remains critical in the detection of structural fetal anomalies. Our study aimed to determine the prevalence of abnormalities on routine FAS performed by a single operator, who is an experienced sub-specialist in maternal-fetal medicine.
METHODS
A retrospective analysis of all routine FAS performed a tertiary private obstetric ultrasound practice in metropolitan Sydney over a 7-year period, August 2015-July 2022. An advanced ultrasound protocol including detailed cardiac views was used in every case. Second opinion scans for suspected abnormalities were excluded. Fetal anomalies were classified into major and minor, based on the likely need for neonatal intervention.
RESULTS
Among 14,908 obstetric ultrasound examinations, routine FAS were performed on 3172 fetuses by a single operator. More than 99% of women had screened low-risk for fetal aneuploidy. Structural anomalies were identified in 5% (157/3172) of fetuses; the prevalence of major anomalies was 1% (30/3172). Almost 60% of total anomalies were either cardiac or renal. No differences were identified in anomaly rates for singletons compared with twins (5.0% vs. 4.2%; P = 0.75). The prevalence of placenta previa and vasa previa was 10% and 0.1%, respectively.
DISCUSSION
The prevalence of fetal anomalies on routine FAS by a single operator using a standardised protocol was higher in our practice (5%) than in previously published studies. Although most anomalies were minor, the rate of major abnormality was 1%.
CONCLUSION
The routine mid-trimester FAS remains an integral component of prenatal ultrasound screening.
PubMed: 38434547
DOI: 10.1002/ajum.12369 -
Journal of Ultrasound in Medicine :... Apr 2024
Topics: Female; Humans; Pregnancy; Vasa Previa; Placenta; Umbilical Cord; Ultrasonography, Prenatal; Placenta Previa
PubMed: 38293820
DOI: 10.1002/jum.16420 -
Obstetrics and Gynecology Feb 2024
Topics: Female; Humans; Pregnancy; Perinatal Death; Perinatal Mortality; Prenatal Diagnosis; Vasa Previa
PubMed: 38237163
DOI: 10.1097/AOG.0000000000005486 -
Seminars in Perinatology Feb 2024Stillbirth affects a large proportion of pregnancies world-wide annually and continues to be a major public health concern. Several causes of stillbirth have been...
Stillbirth affects a large proportion of pregnancies world-wide annually and continues to be a major public health concern. Several causes of stillbirth have been identified and include obstetrical complications, placental abnormalities, fetal malformations, infections, and medical complications in pregnancy. Placental abnormalities such as placental abruption, chorioangioma, vasa previa, and umbilical cord abnormalities have been identified as causes of death for a significant proportion of stillbirths. In the absence of placental abnormalities, the gross and histologic changes in the placenta in stillbirth are found when secondary to other etiologies. Here we describe both gross and histologic changes of the placenta that are associated with stillbirth.
Topics: Pregnancy; Female; Humans; Stillbirth; Placenta; Placenta Diseases; Abruptio Placentae; Public Health
PubMed: 38199875
DOI: 10.1016/j.semperi.2023.151871 -
Ultrasound in Obstetrics & Gynecology :... Dec 2023
PubMed: 38145553
DOI: 10.1002/uog.27567 -
European Journal of Obstetrics,... Feb 2024
Topics: Humans; Female; Pregnancy; Vasa Previa; Outpatients; Prenatal Diagnosis; Ultrasonography, Prenatal; Risk
PubMed: 38123373
DOI: 10.1016/j.ejogrb.2023.12.017