-
Clinical Case Reports Mar 2022Vasa previa is a rare condition. However, since the increase in assisted reproductive technologies (ARTs), clinicians are more frequently confronted with this...
Vasa previa is a rare condition. However, since the increase in assisted reproductive technologies (ARTs), clinicians are more frequently confronted with this complication. In this study, we present five cases of vasa previa prenatally diagnosed from a tertiary referral hospital with approximately 2000 births yearly.
PubMed: 35356178
DOI: 10.1002/ccr3.5608 -
Ultrasound in Obstetrics & Gynecology :... May 2015Vasa previa is an obstetric complication in which the fetal blood vessels lie outside the chorionic plate in close proximity to the internal cervical os. In women with... (Review)
Review
OBJECTIVE
Vasa previa is an obstetric complication in which the fetal blood vessels lie outside the chorionic plate in close proximity to the internal cervical os. In women with vasa previa, the risk of rupture of these vessels is increased, thus potentially causing fetal death or serious morbidity. Our objective was to assess the accuracy of ultrasound in the prenatal diagnosis of vasa previa.
METHODS
We searched MEDLINE, EMBASE, the Cochrane Library and PubMed for studies on vasa previa. Two reviewers independently selected studies on the accuracy of ultrasound in the diagnosis of vasa previa. The studies were scored on methodological quality using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). Data on sensitivity and specificity were subsequently extracted.
RESULTS
The literature search revealed 583 articles, of which two prospective and six retrospective cohort studies were eligible for inclusion in the qualitative analysis. All studies documented methods suitable for the prenatal diagnosis of vasa previa. Four out of the eight studies used transvaginal ultrasound (TVS) for primary evaluation, while the remaining four studies used transabdominal ultrasound and performed a subsequent TVS when vasa previa was suspected. The QUADAS-2 tool reflected poor methodology in six of the eight included studies, and prenatal detection rates varied from 53% (10/19) to 100% (total of 442,633 patients, including 138 cases of vasa previa). In the two prospective studies (n = 33,795, including 11 cases of vasa previa), transvaginal color Doppler performed during the second trimester detected all cases of vasa previa (sensitivity, 100%) with a specificity of 99.0-99.8%.
CONCLUSION
The accuracy of ultrasound in the diagnosis of vasa previa is high when performed transvaginally in combination with color Doppler.
Topics: Adult; Female; Humans; Placenta; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Prospective Studies; Retrospective Studies; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 25491755
DOI: 10.1002/uog.14752 -
Acta Obstetricia Et Gynecologica... Sep 2021The presence of vasa previa carries a high risk for severe fetal morbidity and mortality due to fetal bleeding caused by injury to unprotected fetal vessels when rupture...
INTRODUCTION
The presence of vasa previa carries a high risk for severe fetal morbidity and mortality due to fetal bleeding caused by injury to unprotected fetal vessels when rupture of membranes occurs. Previously, it has been shown that prenatal diagnosis significantly improves the outcome. However, systematic screening for vasa previa is not generally performed and clinical studies demonstrating the performance of systematic screening for vasa previa in routine clinical practice are rare. The objective of this study was to assess the performance of systematic screening for vasa previa by determining placental cord insertion at the 20-week anomaly scan.
MATERIAL AND METHODS
This is a retrospective study of 6038 pregnant women between 18+0 and 24+0 gestational weeks who were prospectively screened for vasa previa by depiction of the site of placental cord insertion at the 20-week anomaly scan. Pregnancies with marginal or velamentous cord insertion underwent vaginal sonography for examination for vasa previa. In cases with succenturiate or bilobed placentas, the bridging vessels were depicted, and vaginal sonography was performed if necessary.
RESULTS
There were 21 cases of vasa previa and all were diagnosed prenatally. In 18 cases, the cord insertion was marginal or velamentous. The remaining three cases had placental anomalies, which necessitated a detailed examination. All pregnancies with vasa previa were delivered at a mean of 35.2 (SD 1.8) gestational weeks by cesarean section. Among pregnancies affected by vasa previa, all fetuses survived. The median birthweight was 2390 g (range 1200-2990 g) and the mean umbilical artery pH 7.34 (SD 0.04). The median 5-min APGAR score was nine (range 7-10). None of the fetuses or neonates died or required blood transfusions. In all pregnancies of the whole cohort which were complicated by fetal or neonatal demise and in neonates with a 5-min APGAR score ≤5 and/or an umbilical artery pH ≤7.10, fetal blood loss was excluded as a cause of the poor obstetric outcome.
CONCLUSIONS
Screening for vasa previa is feasible and efficient, taking into account the site of placental cord insertion in pregnancies not affected by placenta previa and bilobed and succenturiate placenta.
Topics: Adult; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Prospective Studies; Retrospective Studies; Ultrasonography, Prenatal; Vasa Previa
PubMed: 34077551
DOI: 10.1111/aogs.14205 -
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 -
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 :... Feb 2018
Topics: Extraembryonic Membranes; Female; Humans; Pregnancy; Pregnancy Trimester, Second; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 28556510
DOI: 10.1002/uog.17532 -
American Journal of Obstetrics and... Oct 2015The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies.... (Review)
Review
The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies. Twins are at higher risk of aneuploidy, structural anomalies, and placental abnormalities. Some of the placental and umbilical cord abnormalities found in twin gestations are nonspecific and can be found in singleton gestations (ie, placenta previa, placental abruption, single umbilical artery, velamentous cord insertion, vasa previa, etc). However, other anomalies are unique to twin gestations, and are mainly associated with monochorionic twins-these include intraplacental anastomosis and cord entanglement. Most of these conditions can be diagnosed with ultrasound. An accurate and early diagnosis is important in the management of twin gestations. Determination of chorionicity, amnionicity, and the identification of placental anomalies are key issues for the adequate management of twin pregnancies. Pathologic placental examination after delivery can help in assessing the presence of placental and umbilical cord abnormalities, as well as providing information about chorionicity and gaining insight into the potential mechanisms of disease affecting twin gestations.
Topics: Chorion; Female; Fetal Development; Humans; Hydatidiform Mole; Placenta; Placenta Diseases; Pregnancy; Pregnancy, Twin; Twins, Dizygotic; Twins, Monozygotic; Ultrasonography, Prenatal; Umbilical Cord; Vascular Fistula
PubMed: 26428508
DOI: 10.1016/j.ajog.2015.06.054 -
Ultrasound in Obstetrics & Gynecology :... Aug 2001To assess the specificity of sonographic diagnosis of vasa previa and pregnancy outcome in sonographically diagnosed cases.
OBJECTIVE
To assess the specificity of sonographic diagnosis of vasa previa and pregnancy outcome in sonographically diagnosed cases.
METHODS
We prospectively collected cases of vasa previa diagnosed by color Doppler sonography. Delivery by elective Cesarean section after demonstration of fetal pulmonary maturity and prior to the onset of labor was recommended unless obstetric complications supervened. Data regarding maternal obstetric courses and newborn status were collected.
RESULTS
Eleven cases of vasa previa without placenta previa were diagnosed among 33 208 women over an 8-year period. Ten patients had confirmation of the diagnosis by the delivering obstetrician and/or placental examination, giving a specificity of diagnosis of 91%. Among the 10 patients with confirmed vasa previa, two were delivered at 31.5 and 35.5 weeks' gestation prior to demonstration of lung maturity, and the remainder were delivered at 34-37.5 weeks, after lung maturity. All infants had normal Apgar scores and survived. One baby had Scimitar syndrome, which was not suspected from sonography.
CONCLUSIONS
The specificity of sonographic diagnosis of vasa previa at our center was 91%. Antenatal diagnosis permitted us to prevent the catastrophic outcomes commonly associated with vasa previa.
Topics: Adult; Cesarean Section; Female; Humans; Placenta; Placenta Previa; Pregnancy; Pregnancy Outcome; Prospective Studies; Risk Factors; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Uterine Hemorrhage
PubMed: 11529988
DOI: 10.1046/j.1469-0705.2001.00448.x -
Ultrasound in Obstetrics & Gynecology :... Feb 2010Our aim was to assess the current use of obstetric ultrasound imaging for the diagnosis of asymptomatic vasa previa. We also investigated obstetricians' views on the...
OBJECTIVES
Our aim was to assess the current use of obstetric ultrasound imaging for the diagnosis of asymptomatic vasa previa. We also investigated obstetricians' views on the feasibility of a screening policy and their awareness of risk factors associated with this condition.
METHODS
A national postal survey was conducted between March and July 2006. A total of 234 questionnaires were sent to obstetric and fetomaternal consultants across England and Wales. In all, 128 questionnaires were returned, a response rate of 55%.
RESULTS
Most respondents (85%) stated that in their hospital they do not report velamentous cord insertions at the anomaly scan. However, 73% occasionally or routinely document the presence of succenturiate lobes. Only 33% of respondents offered transvaginal scanning for the identification of vasa previa within their hospital, whereas only 6% had ever referred women to a tertiary center for this indication. In all, 34% of the respondents did not identify any risk factor for the condition. Most respondents (80%) would offer an elective Cesarean section if vasa previa was suspected antenatally; the majority would perform it at 38 weeks' gestation. However, only 20% of respondents felt that an effective screening policy is possible.
CONCLUSIONS
Despite evidence that perinatal death can be prevented by antenatal diagnosis of vasa previa, most obstetricians in England and Wales feel that a screening policy is not possible. The majority of them would offer an elective Cesarean section for vasa previa at around 38 weeks. There is a need to increase awareness and understanding of the major risk factors for this condition.
Topics: England; Feasibility Studies; Female; Gestational Age; Health Care Surveys; Humans; Obstetrics; Placenta Diseases; Practice Patterns, Physicians'; Pregnancy; Referral and Consultation; Risk Factors; Surveys and Questionnaires; Ultrasonography, Prenatal; Vasa Previa; Wales
PubMed: 20014327
DOI: 10.1002/uog.7466 -
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