158: Prenatal diagnosis, antenatal surveillance, and timing of delivery for vasa previa: a national survey

Vasa Praevia: a descriptive review of existing literature and the evolving role of ultrasound in prenatal screening

“…Mounting evidence suggests that risk factors for VP can be identified by the time of the routine second trimester morphology scan, yet there is still an apparent lack of consensus in the obstetric community as to whether routine prenatal screening for VP is actually feasible, and there is little reliable data available to indicate whether it is being achieved. A recent survey of members of the Society for Maternal‐Fetal Medicine in the United States revealed that only 43% of maternal‐fetal medicine specialists had a protocol for screening 54 . The results of a survey sent to all obstetric and fetal‐maternal consultants across England and Wales in 2006 55 were also significant in demonstrating that 30% of respondents could not name a single risk factor for VP and only 33% were offering transvaginal colour Doppler scans for identification of fetal vessels over the cervical os.…”

“…A recent survey of members of the Society for Maternal-Fetal Medicine in the United States revealed that only 43% of maternal-fetal medicine specialists had a protocol for screening. 54 The results of a survey sent to all obstetric and fetal-maternal consultants across England and Wales in 2006 55 were also significant in demonstrating that 30% of respondents could not name a single risk factor for VP and only 33% were offering transvaginal colour Doppler scans for identification of fetal vessels over the cervical os. However, since the report was published, the Royal College of Obstetricians and Gynaecologists (RCOG) in the UK and the Society of Obstetricians and Gynaecologists of Canada have published guidelines for the diagnosis and management of VP.…”

“…While it is clear that planned caesarean in cases of vasa praevia leads to better outcomes, surveys conducted in both the UK and the USA indicated that only a minority of clinicians offer hospitalisation prior to late preterm elective delivery and even fewer offer steroids for fetal maturation. 54,55 Thus, there does seems to be little consensus on the best management plan, with only the UK and Canada having published practice guidelines. 4,56 While both of these guidelines acknowledge that VP can be diagnosed in most cases during the second trimester fetal anomaly ultrasound scan, neither of them recommend universal screening for VP.…”