Guideline No. 439: Diagnosis and Management of Vasa Previa

Jain, Venu; Gagnon, Robert

doi:10.1016/j.jogc.2023.05.009

Cited by 12 publications

(7 citation statements)

References 52 publications

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“…The diagnosis of vasa previa was established solely based on atypical ultrasonographic findings obtained during transvaginal color Doppler ultrasonography in the second trimester of pregnancy. This facilitated early and evidence-based management of this rare obstetric complication, aiming to reduce perinatal morbidity and mortality during pregnancy and delivery [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of Vasa Previa in the Second Trimester of Pregnancy Based on Non-typical Ultrasound Findings: A Case Report and Mini-Review of the Literature

Thanasa,

Antoniou

et al. 2024

Cureus

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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.

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Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of Vasa Previa in the Second Trimester of Pregnancy Based on Non-typical Ultrasound Findings: A Case Report and Mini-Review of the Literature

Thanasa,

Antoniou

et al. 2024

Cureus

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“…Type 3 vasa previa is when it cannot be classified into the two other types and can be described as when vessels run on the margin of the placenta without velamentous insertion or evidence of a bilobed placenta [10]. Resolution of vasa previa or low-lying fetal vessels can occur in the second and early third trimesters [11]. Classification of vasa previa into distinct types delineates anatomical variations influencing clinical management and prognosis.…”

Section: Vasa Previa: Definition and Diagnosismentioning

confidence: 99%

Vasa Previa and the Role of Fetal Fibronectin and Cervical Length Surveillance: A Review

Oladipo,

Voity,

Murphy

et al. 2024

Diagnostics

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Vasa previa is a pregnancy complication that occurs when unprotected fetal blood vessels traverse the cervical os, placing the fetus at high risk of exsanguination and fetal death. These fetal vessels may be compromised by fetal movement and compression, leading to poor oxygen distribution and asphyxiation. Diagnostic tools for vasa previa management and preterm labor (PTL) include transvaginal ultrasound, cervical length (CL) surveillance and use of fetal fibronectin (FFN) testing. These tools can prove to be quite useful as they allow for lead time in the prediction of PTL and spontaneous rupture of membranes which can result in devastating outcomes for pregnancies affected by vasa previa. We conducted a literature review on vasa previa management and the usefulness of FFN and CL surveillance in predicting PTL and found 36 related papers. Although there is limited research available to show the impact of FFN and CL surveillance in the management of vasa previa, there is sufficient evidence to support FFN and CL surveillance in predicting the onset of PTL, which can have devastating consequences for the pregnancies affected. It can be extrapolated that these tools, by helping to determine pregnancies at risk for PTL, could improve management and outcomes in patients with vasa previa. Future studies investigating the management of vasa previa with FFN and CL surveillance to reduce the burden of PTL and its associated comorbidities are warranted.

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“…Vasa previa (VP) occurs when fetal vessels are exposed within the amniotic membrane between the presenting part of the fetus and the internal cervical os, unprotected by Wharton's jelly or the placental mass. 1 , 2 , 3 , 4 These vessels are at substantial risk of injury at the time of cervical dilatation and membrane rupture, which can result in rapid fetal exsanguination. The condition is consequently associated with perinatal mortality of up to 60% if undetected antenatally.…”

Section: Introductionmentioning

confidence: 99%

Incorporation of vasa previa screening into a routine anomaly scan: A single center cohort study

Nwandison,

Daly‐Jones,

Drought

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionVasa previa (VP), defined as unprotected fetal vessels traversing the membranes over the cervix, is associated with a high perinatal mortality when undiagnosed prenatally. Conversely, prenatal diagnosis with ultrasound and cesarean delivery before the membranes rupture is associated with excellent outcomes. However, controversy exists regarding screening for VP. In the UK, routine screening for VP is not recommended. The objective of this study was to report the incidence of VP and our experience in the detection of VP with a universal screening protocol at the time of the second‐trimester fetal anomaly scan with third‐trimester confirmation in an unselected population of pregnancies.Material and methodsWe performed a single‐center historical cohort study of all pregnant women who underwent routine second‐trimester anomaly screening scans at West Middlesex University Hospital, London, UK, between 2012 and 2016. Over 5 years, every patient undergoing routine anomaly screening was evaluated for VP using a systematic protocol during their 20‐week anomaly scan. Suspected cases of VP were rescanned in the third trimester by specialist sonographers with an interest in VP. The primary outcomes were the incidence and detection of VP.ResultsDuring the study period, 24 690 anatomy scans were performed. A total of 64 patients were identified as having potential VP at the second‐trimester anomaly screening scan, of which 19 were confirmed by the specialist sonographer in the third trimester and at delivery. The screen positive rate was 0.26% (95% confidence interval [CI] 0.20%–0.32%). VP at birth was found in 19/24690 births (1:1299 [95% CI: 1:832–1:2030] births). Universal screening for VP using our protocol had a sensitivity of 100% and a specificity of 99.78% (95% CI: 99.72%–99.84%). The false‐positive rate of the second‐trimester screen was 0.18% (95% CI: 0.13–0.24). There were no false positives or false negatives at delivery. Of the 19 patients with confirmed VP, 17 had scheduled cesarean deliveries, and two required emergency deliveries due to antepartum hemorrhage. One baby died, giving a perinatal mortality of 5%.ConclusionsVP complicates approximately 1:1300 pregnancies. Routine screening for VP yielded a 100% detection rate. We suggest the inclusion of structured VP assessment in standard fetal anomaly screening programs.

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Guideline No. 439: Diagnosis and Management of Vasa Previa

Cited by 12 publications

References 52 publications

Prenatal Diagnosis of Vasa Previa in the Second Trimester of Pregnancy Based on Non-typical Ultrasound Findings: A Case Report and Mini-Review of the Literature

Prenatal Diagnosis of Vasa Previa in the Second Trimester of Pregnancy Based on Non-typical Ultrasound Findings: A Case Report and Mini-Review of the Literature

Vasa Previa and the Role of Fetal Fibronectin and Cervical Length Surveillance: A Review

Incorporation of vasa previa screening into a routine anomaly scan: A single center cohort study

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