In Vitro Fertilization and Vasa Previa: A Report of Two Cases

Abstract

Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

“…An association of vasa previa with IVF pregnancies was also reported by Oyelese et al and Isotton et al 156 , 157 …”

“…154 In a review study, Jauniaux et al confirmed that the incidence of twin gestations diagnosed with vasa previa in cohort and case-control studies was 11% and concluded that there is sufficient evidence to warrant guidelines for targeted screening. 155 An association of vasa previa with IVF pregnancies was also reported by Oyelese et al and Isotton et al 156,157 Marginal Insertion of the Umbilical Cord Of note, it appears that attention should also be directed at sonographic depiction of marginal umbilical cord insertion (Figures 4 and 5) in that this condition has been associated with an increase in both adverse maternal and perinatal outcomes. 106,158…”

The Case for Umbilical Cord Screening Via Ultrasound at 18–20 Weeks

“…Animal model studies have revealed that repetitive UC compression disturbs the fetal acid-base status and can ultimately result in cardiovascular collapse [39,40]. These studies clearly indicate that UCA is the cause of stillbirth.…”

“…Pregnant women must always be informed of these findings by the obstetrician and/or nurse-midwife. The possibility of stillbirth far outweighs any concerns regarding maternal anxiety [39,40].…”

Treatment of Pernicious Placenta Previa with Ergonoxine and Spiral Suture of Lower Uterine Segment

“…PPP refers to the placenta attached to the scar of the previous cesarean section, or the placenta previa with placenta accreta or placental adhesions. Relevant data show that the risk of placental implantation is 50 %, which may lead to intraoperative and postoperative bleeding that is difficult to control during cesarean section, which may cause hemorrhagic shock and diffuse intravascular coagulation, endangering the life of the mother and increase perinatal hysterectomy rate [3][4][5] . With the opening of the two-child policy, it is foreseeable that the cesarean section rate, which was as high as 50 % in China, will cause a huge number of PPP parturients, and how to deal with the intraoperative bleeding is one of the most pressing problems for obstetricians in China [6,7] .…”