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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 -
F1000Research 2013We present here a case of vasa previa in a multipara, diagnosed at the time of her late second trimester ultrasonogram. The patient subsequently underwent an elective...
We present here a case of vasa previa in a multipara, diagnosed at the time of her late second trimester ultrasonogram. The patient subsequently underwent an elective cesarean section after 37 weeks gestation, giving birth to a healthy child with an uneventful post-partum, neonatal and infant course. At the time of cesarean section, the incision was gradually deepened in layers through the myometrium by utmost care allowing the amniotic sac to protrude through the uterine incision hereby avoiding laceration of the vasa previa and its branches. Fetal exsanguination and a need for blood transfusion as well as a possible adverse neonatal course were therefore avoided.
PubMed: 25075282
DOI: 10.12688/f1000research.2-267.v1 -
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 -
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 -
Iranian Journal of Public Health Jan 2014Most fetal heart rate patterns can be interpreted accurately so that management decisions can be made correctly. How-ever, few fetal heart rate patterns are so ambiguous...
Most fetal heart rate patterns can be interpreted accurately so that management decisions can be made correctly. How-ever, few fetal heart rate patterns are so ambiguous that the obstetricians cannot interpret them precisely. A 27-year-old woman at 38 weeks' gestation in her first pregnancy was admitted with heavy vaginal bleeding and decrease in fetal movements. Fetal status was indeterminate according to an indefinite fetal heart rate tracing with regular decelerations. After emergent cesarean delivery, a ruptured vasa previa, traversing the fetal membrane, unsupported by either the umbilical cord or placental tissue, was clearly identified. Treatment decision-making is challenging in such patient with indefinite fetal heart rate pattern because limited data exist to guide management. Well-designed studies are needed to clarify the uncertainty about the effect of indefinite fetal heart rate pattern on clinical outcomes.
PubMed: 26060689
DOI: No ID Found -
Ultrasound in Obstetrics & Gynecology :... Sep 2021
Topics: Adult; Cervix Uteri; Cesarean Section; Diagnosis, Differential; Female; Fetus; Humans; Live Birth; Medical Illustration; Pregnancy; Ultrasonography, Prenatal; Vasa Previa
PubMed: 32991754
DOI: 10.1002/uog.23133 -
Ultrasound in Obstetrics & Gynecology :... Dec 1998Vasa previa is a cause of sudden unanticipated fetal death, with a fetal mortality of 33-100%. Transvaginal sonography (TVS) and color Doppler may aid in making the...
Vasa previa is a cause of sudden unanticipated fetal death, with a fetal mortality of 33-100%. Transvaginal sonography (TVS) and color Doppler may aid in making the diagnosis antenatally, allowing elective Cesarean delivery, thereby avoiding fetal death from exsanguination which would occur if the membranes were allowed to rupture in labor. Whilst it is not feasible to screen all pregnant women for vasa previa, antenatal examination with TVS and color Doppler of women at risk, specifically those with low-lying placentas, bi-lobed, multi-lobed and succenturiate-lobed placentas, multiple pregnancies and pregnancies resulting from in vitro fertilization may lead to antenatal diagnosis of the condition. We present the last three cases of vasa previa to have occurred in our institution, two of which were diagnosed antenatally using TVS and color Doppler. In all three cases, routine 20-week obstetric sonography revealed low-lying placentas; in only one of these did the placenta remain low at term. A low-lying placenta at 20 weeks may be a risk factor for vasa previa; we suggest that further studies be carried out to ascertain this. Judicious use of TVS and color Doppler in women considered at risk of vasa previa may help to reduce the mortality from this condition.
Topics: Cesarean Section; Female; Fetal Death; Humans; Infant, Newborn; Labor Presentation; Placenta; Pregnancy; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Cord
PubMed: 9918094
DOI: 10.1046/j.1469-0705.1998.12060434.x -
Revista Brasileira de Ginecologia E... Aug 2020
Topics: Adult; Female; Humans; Placenta; Pregnancy; Ultrasonography, Prenatal; Vasa Previa
PubMed: 32898915
DOI: 10.1055/s-0040-1713914 -
BMJ Case Reports Oct 2017We present a case of a 42-year-old woman with a pregnancy resulting from in vitro fertilisation and a medical history including two spontaneous abortions,...
We present a case of a 42-year-old woman with a pregnancy resulting from in vitro fertilisation and a medical history including two spontaneous abortions, hypercoagulable state and other comorbidities. At 13 4/7 weeks' gestation, during research ultrasonography, the patient was noted to have an anterior succenturiate placental lobe. Following an episode of vaginal bleeding at 21 6/7 weeks, she was diagnosed with a low-lying posterior placental lobe. Velamentous cord insertion, placenta previa and vasa previa were excluded at that time. After elective induction for advanced maternal age at 39 0/7 weeks, arrest of labour and chorioamnionitis resulted in a primary low transverse caesarean section and delivery of a healthy girl at 39 3/7 weeks. Gross examination of the placenta showed an irregular, singleton placenta with an attached succenturiate lobe and a marginally inserting umbilical cord. Both lobes were connected by two vessels.
Topics: Adult; Cesarean Section; Comorbidity; Early Diagnosis; Female; Fertilization in Vitro; Humans; Live Birth; Obstetric Labor Complications; Placenta Diseases; Pregnancy; Ultrasonography, Prenatal
PubMed: 29021145
DOI: 10.1136/bcr-2017-222189 -
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