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Ultrasound in Obstetrics & Gynecology :... May 2020To examine the feasibility and effectiveness of a two-stage ultrasound screening strategy for detection of vasa previa and to estimate the potential impact of screening...
OBJECTIVES
To examine the feasibility and effectiveness of a two-stage ultrasound screening strategy for detection of vasa previa and to estimate the potential impact of screening on prevention of stillbirth.
METHODS
This was a retrospective study of data from prospective screening for vasa previa in singleton pregnancies, undertaken at the Fetal Medicine Unit at Medway Maritime Hospital, UK, between 2012 and 2018. Women booked for prenatal care and delivery in our hospital had routine ultrasound examinations at 11-13 and 20-22 weeks' gestation. Those with velamentous cord insertion at the inferior part of the placenta at the first-trimester scan and those with low-lying placenta at the second-trimester scan were classified as high-risk for vasa previa and had transvaginal sonography searching specifically for vasa previa, at the time of the 20-22-week scan. The management and outcome of cases with suspected vasa previa is described. We excluded cases of miscarriage or termination at < 24 weeks' gestation.
RESULTS
The study population of 26 830 singleton pregnancies included 21 (0.08%; 1 in 1278) with vasa previa. In all cases of vasa previa, the diagnosis was made at the 20-22-week scan and confirmed postnatally by gross and histological examination of the placenta. At the 11-13-week scan, cord insertion was classified as central in 25 071 (93.4%) cases, marginal in 1680 (6.3%), and velamentous in 79 (0.3%). In 16 (76.2%) of the 21 cases of vasa previa, cord insertion at the first-trimester scan was classified as velamentous at the inferior part of the placenta, in two cases (9.5%) as marginal and in three cases (14.3%) as central. The 21 cases of vasa previa were managed on an outpatient basis with serial scans for measurement of cervical length and elective Cesarean section at 34 weeks' gestation; all babies were liveborn but there was one neonatal death. In the study population, there were 83 stillbirths, none of which had evidence of vasa previa on postnatal examination. On the assumption that, if we had not diagnosed prenatally all 21 cases of vasa previa in our population, half of these cases would have resulted in stillbirth, then the potential impact of screening is prevention of 10.6% (10/94) of stillbirths.
CONCLUSION
A two-stage strategy of screening for vasa previa can be incorporated into routine clinical practice, and such a strategy could potentially reduce the rate of stillbirth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Feasibility Studies; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Placenta Diseases; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prospective Studies; Retrospective Studies; Stillbirth; Ultrasonography, Prenatal; Vasa Previa
PubMed: 31840871
DOI: 10.1002/uog.21953 -
Women and Birth : Journal of the... Apr 2024Many studies have reported interventions for women with vasa praevia to improve perinatal outcomes. However, which outcomes are important for women remains unclear.
BACKGROUND
Many studies have reported interventions for women with vasa praevia to improve perinatal outcomes. However, which outcomes are important for women remains unclear.
AIM
To explore what outcomes are important for women with lived experience of vasa praevia and why, in order to inform the development of a core outcome set for studies on vasa praevia.
METHODS
An international qualitative study was conducted with women and clinicians. Semi-structured interviews were audio-recorded, transcribed, and analysed taking an inductive approach.
FINDINGS
Eighteen women and six clinicians (four obstetricians, two midwives) from the United States, United Kingdom, Canada, and Australia were interviewed. Participants identified 47 patient-important outcomes and experience measures, which were grouped under five themes: baby's survival and health, mother's physical health, mother's mental and emotional health, quality of health care delivery, and resource use and cost. While survival of the baby without short- and long-term morbidity remained the main priority, other important considerations included the physical, mental, social and financial wellbeing of families, future access to antenatal screening and diagnosis, information on management options and consequences, continuity of care, clear and effective communication, peer support and the appreciation of individual variations to risk tolerance, values and resource availability.
CONCLUSION
We have identified patient-important outcomes and experience measures that have been directly fed into the development of a core outcome set on vasa previa. Incorporating these considerations into both clinical practice and future research studies has the potential to improve outcomes and experiences for women with vasa praevia.
PubMed: 38669723
DOI: 10.1016/j.wombi.2024.101614 -
Romanian Journal of Morphology and... 2016Vasa praevia is a rare but very dangerous obstetrical condition. The purpose of our article is to evaluate data available in literature that indicate in vitro... (Review)
Review
Vasa praevia is a rare but very dangerous obstetrical condition. The purpose of our article is to evaluate data available in literature that indicate in vitro fertilization as a risk factor for vasa praevia. PubMed Library and Cochrane Database were searched using the keywords vasa praevia, in vitro fertilization, velamentous cord insertion, placenta praevia. The conditions related to in vitro fertilization that increase the risk of vasa praevia formation were identified and discussed. Also, the diagnosis and management options were reviewed. In vitro fertilization represents a risk factor for vasa praevia and all such pregnancies should be screened by transvaginal ultrasound for vasa praevia.
Topics: Estradiol; Female; Fertilization in Vitro; Humans; Placenta; Pregnancy; Prenatal Diagnosis; Risk Factors; Vasa Previa
PubMed: 27833953
DOI: No ID Found -
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 Pan African Medical Journal 2014
Topics: Adult; Female; Humans; Placenta; Pregnancy; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 25667717
DOI: 10.11604/pamj.2014.19.55.4487 -
Ultrasound in Obstetrics & Gynecology :... Jul 2021
Topics: Adult; Amnion; Chorion; Extraembryonic Membranes; Female; Humans; Medical Illustration; Pregnancy; Pregnancy Complications; Ultrasonography, Prenatal; Umbilical Cord; Vasa Previa
PubMed: 32770677
DOI: 10.1002/uog.22168 -
International Journal of Women's Health 2021The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in...
The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton's jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl's anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.
PubMed: 34703323
DOI: 10.2147/IJWH.S278747 -
Cureus Apr 2024Vasa previa is a rare disorder of the placenta. The absence of a prenatal diagnosis is associated with increased perinatal morbidity and mortality. In our patient,...
Vasa previa is a rare disorder of the placenta. The absence of a prenatal diagnosis is associated with increased perinatal morbidity and mortality. In our patient, ultrasound findings, although atypical, successfully established the prenatal diagnosis of vasa previa in the second trimester of pregnancy. Despite the fact that the placenta was not low-lying, that it was not possible to visualize the site of umbilical cord insertion into the placental tissue, and that vasa previa was not directly visualized, the presence of blood flow near and around the internal cervical os, as seen on transvaginal Doppler ultrasound in the second and third trimesters of pregnancy, raised serious suspicion of their presence. With the completion of the 36th gestational week, it was decided to proceed with a scheduled cesarean section. One week earlier, a course of corticosteroids was administered. The cesarean section was performed without complications. After placental delivery, the presence of velamentous umbilical cord insertion was noted, with umbilical vessels coursing unprotected by the placental tissue or umbilical cord within the fetal membranes. The puerperant and the newborn were discharged from the obstetrics clinic of the General Hospital of Trikala in excellent condition. This paper highlights the importance of transvaginal color Doppler ultrasound in the prenatal diagnosis of vasa previa, which, while posing little risk to the mother, can often be fatal to the fetus.
PubMed: 38765444
DOI: 10.7759/cureus.58575 -
Journal of Medical Ultrasound 2023A 33-year-old woman, gravida 2 para 0, with a history of two previous miscarriages, underwent an investigation for recurrent miscarriage. After genetic counseling, the...
A 33-year-old woman, gravida 2 para 0, with a history of two previous miscarriages, underwent an investigation for recurrent miscarriage. After genetic counseling, the couple were submitted to the karyotype, which resulted in 45, X/46, XX mosaicism (mosaic Turner syndrome) in the wife result, while the husband chromosomal resulted in 46, XY (normal). After evaluating the options, the couple opted for fertilization. During prenatal follow-up, placenta and vasa previa were identified, considerably increasing the maternal-fetal mortality rate in this case. However, despite being a delicate and challenging case, the early diagnose was possible due to transvaginal ultrasound using color Doppler. Due to good care in obstetric follow-up, involving a multidisciplinary team, a therapeutic program and a successful outcome were possible. The patient underwent a cesarean section at 35 weeks of pregnancy, without complications, with a newborn in good general condition, despite the prematurity.
PubMed: 38025015
DOI: 10.4103/jmu.jmu_16_22 -
PloS One 2021Low-birthweight (LBW; <2,500 g) babies are at a higher risk of poor educational achievement, disability, and metabolic diseases than normal-birthweight babies in the...
Low-birthweight (LBW; <2,500 g) babies are at a higher risk of poor educational achievement, disability, and metabolic diseases than normal-birthweight babies in the future. However, reliable data on factors that contribute to LBW have not been considered previously. Therefore, we aimed to examine the distribution of the causes for LBW. A retrospective review of cases involving 4,224 babies whose mothers underwent perinatal care at Keio University Hospital between 2013 and 2019 was conducted. The LBW incidence was 24% (1,028 babies). Of the 1,028 LBW babies, 231 babies were from multiple pregnancies. Of the 797 singleton LBW babies, 518 (65%) were born preterm. Obstetric complications in women with preterm LBW babies included premature rupture of membrane or labor onset (31%), hypertensive disorders of pregnancy (HDP, 64%), fetal growth restriction (24%), non-reassuring fetal status (14%), and placental previa/vasa previa (8%). Of the 279 term LBW babies, 109 (39%) were small for gestational age. Multiple logistic regression analyses revealed the following factors as LBW risk factors in term neonates: low pre-pregnancy maternal weight, inadequate gestational weight gain, birth at 37 gestational weeks, HDP, anemia during pregnancy, female sex, and neonatal congenital anomalies. HDP was an LBW risk factor not only in preterm births but also in term births. Our results suggest that both modifiable and non-modifiable factors are causes for LBW. It may be appropriate to consider a heterogeneous rather than a simple classification of LBW and to evaluate future health risks based on contributing factors.
Topics: Female; Gestational Weight Gain; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Japan; Male; Pregnancy; Retrospective Studies; Risk Factors
PubMed: 34161392
DOI: 10.1371/journal.pone.0253719