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European Journal of Obstetrics,... Feb 2024Vasa praevia is a serious pregnancy complication that is potentially life-threatening for the fetus. The possible benefits of prophylactic hospital admission of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Vasa praevia is a serious pregnancy complication that is potentially life-threatening for the fetus. The possible benefits of prophylactic hospital admission of asymptomatic women diagnosed with vasa praevia antenatally remain unclear. This study aims to compare the pregnancy outcomes of inpatient versus outpatient management in women with a prenatal diagnosis of vasa praevia.
METHODS
A systematic search of four electronic databases was conducted and two reviewers independently screened studies for eligibility. The inclusion criteria incorporated studies with prenatally diagnosed vasa praevia, a distinction on whether women were managed as inpatients and/or outpatients and where perinatal mortality was recorded as an outcome. The primary outcome of the study was perinatal mortality with additional outcomes of perinatal morbidity, need for emergency caesarean and antenatal steroid administration. Reporting of the results followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
RESULTS
The search produced 2,300 studies with ten of these studies included in the qualitative synthesis and four included in the quantitative analysis. There was no significant difference in perinatal mortality (OR 1.12, 95 % CI 0.10-12.07, p = 0.93, I = 0 %) or morbidity between women managed as inpatients or outpatients. The prophylactic inpatient group had higher rates of earlier gestational delivery and antenatal corticosteroid administration (OR 10.78, 95 % CI 1.07-108.74, p = 0.04, I = 82 %), but lower rates of emergency caesareans (OR 0.35, 95 % CI 0.17-0.72, p = 0.004, I = 0 %).
CONCLUSION
There were no significant differences in perinatal mortality or morbidity rates observed between inpatient and outpatient management of asymptomatic women with antenatally diagnosed vasa praevia. However, outpatient management is associated with prolonged gestation, a decrease in antenatal corticosteroid administration, and higher odds of emergency caesarean. Outpatient management of prenatally diagnosed vasa praevia seems appropriate for carefully selected asymptomatic women.
Topics: Pregnancy; Female; Humans; Vasa Previa; Outpatients; Inpatients; Prenatal Diagnosis; Perinatal Death; Adrenal Cortex Hormones
PubMed: 38057179
DOI: 10.1016/j.ejogrb.2023.11.033 -
Journal of Ultrasound in Medicine :... Mar 2024Our institution introduced universal vasa previa (VP) screening utilizing transabdominal ultrasound with color Doppler for all pregnancies at the second trimester...
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.
Topics: Pregnancy; Female; Humans; Vasa Previa; Umbilical Cord; Ultrasonography, Prenatal; Ultrasonography, Doppler, Color; Pregnancy Trimester, Second
PubMed: 38009660
DOI: 10.1002/jum.16378 -
Case Reports in Women's Health Dec 2023Type 3 vasa previa is a new concept. Herein, a case is reported of a 35-year-old woman, pregnant following in vitro fertilization, in whom vasa previa was detected on...
Type 3 vasa previa with no low-lying placenta, with central umbilical cord insertion at the upper uterine segment, and with aberrant vessels on the broad membrane: A case report.
Type 3 vasa previa is a new concept. Herein, a case is reported of a 35-year-old woman, pregnant following in vitro fertilization, in whom vasa previa was detected on color Doppler ultrasound at 26 weeks, with no finding of a low-lying placenta. A cesarean section was performed at 34 weeks and 3 days. Gross examination of the placenta showed Type 3 vasa previa with findings somewhat different from previous reports: two aberrant fetal vessels with branching on the broad membrane, and central cord insertion which was farther from the longitudinal center of the placenta than were the running vessels on the membrane. Vasa previa cannot be excluded due to normal cord insertion at the upper uterine segment, absence of placenta previa, or a low-lying placenta in the second trimester. Careful ultrasound screening can promote neonatal survival in patients with Type 3 vasa previa.
PubMed: 37946796
DOI: 10.1016/j.crwh.2023.e00558 -
Medicina (Kaunas, Lithuania) Sep 2023: Vasa previa (VP) is a significant perinatal complication that can have serious consequences for the fetus/neonate. Velamentous cord insertion (VCI) is a crucial...
: Vasa previa (VP) is a significant perinatal complication that can have serious consequences for the fetus/neonate. Velamentous cord insertion (VCI) is a crucial finding in prenatal placental morphology surveillance as it is indicative of comorbid VP. Assisted reproductive technology (ART) has been identified as a risk factor for VCI, so identifying risk factors for VCI in ART could improve VP recognition. This study aims to evaluate the displacement of umbilical cord insertion (CI) from the placental center and to examine the relationship between the modes of conception. : We conducted a retrospective study at the Obstetrics Department of Osaka Metropolitan University Hospital in Japan between May 2020 and June 2022. The study included a total of 1102 patients who delivered after 22 weeks of gestation. They were divided into three groups: spontaneous pregnancy, conventional in vitro fertilization (cIVF), and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). We recorded patient background information, perinatal complications, perinatal outcomes, and a numerical "displacement score", indicating the degree of separation between umbilical CI and the placental center. : The displacement score was significantly higher in the cIVF and IVF/ICSI groups compared with the spontaneous conception group. Additionally, the IVF/ICSI group showed a significantly higher displacement score than the cIVF group. : Our study provides the first evidence that the methods of ART can affect the location of umbilical CI on the placental surface. Furthermore, we found that IVF/ICSI may contribute to greater displacement of CI from the placental center.
Topics: Infant, Newborn; Pregnancy; Humans; Male; Female; Sperm Injections, Intracytoplasmic; Vasa Previa; Retrospective Studies; Placenta; Semen; Umbilical Cord; Reproductive Techniques, Assisted; Vascular Diseases
PubMed: 37893433
DOI: 10.3390/medicina59101715 -
Journal of Environmental and Public... 2023[This retracts the article DOI: 10.1155/2022/1685783.].
[This retracts the article DOI: 10.1155/2022/1685783.].
PubMed: 37811413
DOI: 10.1155/2023/9864294 -
BMC Pregnancy and Childbirth Oct 2023Antepartum 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...
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.
Topics: Pregnancy; Female; Humans; Vasa Previa; Fetal Death; Umbilical Cord; Stillbirth; Ultrasonography, Prenatal; Hemorrhage
PubMed: 37789298
DOI: 10.1186/s12884-023-06019-0 -
Ultrasound in Obstetrics & Gynecology :... Jan 2024
Topics: Pregnancy; Female; Humans; Placenta Previa; Vasa Previa; Placenta; Umbilical Cord; Ultrasonography, Prenatal
PubMed: 37767621
DOI: 10.1002/uog.27505 -
American Journal of Obstetrics and... Jan 2024Vasa previa is an obstetrical condition in which fetal vessels located near the cervix traverse the fetal membranes unprotected by underlying placenta. Type I vasa...
BACKGROUND
Vasa previa is an obstetrical condition in which fetal vessels located near the cervix traverse the fetal membranes unprotected by underlying placenta. Type I vasa previa arises directly from a velamentous cord root, whereas types II and III arise from an accessory lobe or a distal lobe of the same placenta, respectively. Fetoscopic laser ablation for types II and III vasa previa is a novel therapeutic option with benefits that include surgical resolution of the vasa previa, avoidance of prolonged hospitalization, and opportunity for a term vaginal delivery. The potential risks of fetoscopy can be mitigated by delaying laser surgery until a gestational age of 31 to 33 weeks, immediately before anticipated hospitalized surveillance.
OBJECTIVE
This study aimed to assess feasibility and outcomes of types II and III vasa previa patients treated via fetoscopic laser ablation in the third trimester.
STUDY DESIGN
This is a retrospective study of singleton pregnancies with types II and III vasa previa treated with fetoscopic laser ablation at a gestational age ≥31 weeks at a single center between 2006 and 2022. Pregnancy and newborn outcomes were assessed. Continuous variables are expressed as mean±standard deviation.
RESULTS
Of 84 patients referred for vasa previa, 57 did not undergo laser ablation: 19 either had no or resolved vasa previa, 25 had type I vasa previa (laser-contraindicated), and 13 had type II or III vasa previa but declined laser treatment. Of the remaining 27 patients who underwent laser ablation, 7 were excluded (laser performed at <31 weeks and/or twins), leaving 20 study patients. The mean gestational age at fetoscopic laser ablation was 32.0±0.6 weeks, and total operative time was 62.1±19.6 minutes. There were no perioperative complications. All patients had successful occlusion of the vasa previa vessels (1 required a second procedure). All patients were subsequently managed as outpatients. The mean gestational age at delivery was 37.2±1.8 weeks, the mean birthweight was 2795±465 g, and 70% delivered vaginally. Neonatal intensive care unit admission occurred in 3 cases: 1 for respiratory distress syndrome and 2 for hyperbilirubinemia requiring phototherapy. There were no cases of neonatal transfusion, intraventricular hemorrhage, sepsis, patent ductus arteriosus, or death.
CONCLUSION
Laser ablation for types II and III vasa previa at 31 to 33 gestational weeks was technically achievable and resulted in favorable outcomes.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Infant; Pregnancy Trimester, Third; Fetoscopy; Vasa Previa; Retrospective Studies; Placenta
PubMed: 37741533
DOI: 10.1016/j.ajog.2023.09.015 -
BMJ Open Sep 2023To derive accurate estimates of the incidence of vasa praevia (VP) in a routine population of unselected pregnancies. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To derive accurate estimates of the incidence of vasa praevia (VP) in a routine population of unselected pregnancies.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
A search of MEDLINE, EMBASE, CINAHL and the Cochrane database was performed to review relevant citations reporting outcomes in pregnancies with VP from January 2000 until 5 April 2023.
ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES
Prospective or retrospective cohort or population studies that provided data regarding VP cases in routine unselected pregnancies during the study period. We included studies published in the English language after the year 2000 to reflect contemporary obstetric and neonatal practice.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently screened the retrieved citations and extracted data. The methodological quality of studies was assessed using the Newcastle-Ottawa Scale, and Preferred Reporting Items for Systematic reviews and Meta-Analyses was used to ensure standardised reporting of studies.
RESULTS
A total of 3847 citations were screened and 82 full-text manuscripts were retrieved for analysis. There were 24 studies that met the inclusion criteria, of which 12 studies reported prenatal diagnosis with a systematic protocol of screening. There were 1320 pregnancies with VP in a total population of 2 278 561 pregnancies; the weighted pooled incidence of VP was 0.79 (95% CI: 0.59 to 1.01) per 1000 pregnancies, corresponding to 1 case of VP per 1271 (95% CI: 990 to 1692) pregnancies. Nested subanalysis of studies reporting screening for VP based on a specific protocol identified 395 pregnancies with VP in a population of 732 654 pregnancies with weighted pooled incidence of 0.82 (95% CI: 0.53 to 1.18) per 1000 pregnancies (1 case of VP per 1218 (95% CI: 847 to 1901) pregnancies).
CONCLUSION
The incidence of VP in unselected pregnancies is 1 in 1218 pregnancies. This is higher than is previously reported and can be used as a basis to assess whether screening for this condition should be part of routine clinical practice. Incorporation of strategies to screen for VP in routine clinical practice is likely to prevent 5% of stillbirths.
PROSPERO REGISTRATION NUMBER
CRD42020125495.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Incidence; Prospective Studies; Retrospective Studies; Vasa Previa; Databases, Factual
PubMed: 37730391
DOI: 10.1136/bmjopen-2023-075245 -
European Journal of Obstetrics,... Nov 2023
Topics: Pregnancy; Female; Humans; Vasa Previa; Placenta; Lakes; Fetus; Umbilical Cord; Ultrasonography, Prenatal
PubMed: 37726193
DOI: 10.1016/j.ejogrb.2023.09.011