Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa

Abstract

The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for placenta accreta spectrum and vasa previa was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and use of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels.

Type‐3 vasa previa: normal umbilical cord insertion cannot exclude vasa previa in cases with abnormal placental location

“…Some of the vessels branched out from the placental surface and returned subsequently to the placental cotyledons, following a path with a shape similar to the orbit of a boomerang. Vasa previa is known to occur after resolution of placenta previa 3 . These cases highlight a new type of vasa previa (Type 3), in which fetal vessels follow a boomerang orbit, without velamentous cord insertion or bilobed/accessory placenta.…”

First trimester ultrasound prediction of velamentous cord insertions: a prospective study

“…Velamentous cord insertions are associated with fetal and neonatal complications [2,6,9,10,17,18] and a higher risk for vasa previa [13,21,22]. When vasa previa were diagnosed antenatally the neonatal survival rate was 97% compared to 44% only if it was not and the neonatal blood transfusion rate was 3.4% compared to 58.5% [16,17].…”

“…When vasa previa were diagnosed antenatally the neonatal survival rate was 97% compared to 44% only if it was not and the neonatal blood transfusion rate was 3.4% compared to 58.5% [16,17]. Therefore, recent studies recommend universal screening for vasa previa [22]. Also, Ruiter et al [15] consider women with a low cord insertion during first trimester to be at higher risk for vasa previa.…”

A survey of opinion and practice regarding prenatal diagnosis of vasa previa among obstetricians from Australia and New Zealand

“…Prenatal diagnosis of vasa previa (VP) is an important determinant of perinatal outcome . Failure to diagnose VP is associated with high rates of perinatal mortality (40%–60%) and morbidity . Poor outcomes are related to unanticipated rupture of fetal vessels that run unprotected across the supracervical site through the chorionic membrane, rather than being supported by the placenta or the umbilical cord…”

“…[1][2][3][4] Failure to diagnose VP is associated with high rates of perinatal mortality (40%-60%) 2,5 and morbidity. [1][2][3][4][5][6] Poor outcomes are related to unanticipated rupture of fetal vessels that run unprotected across the supracervical site through the chorionic membrane, rather than being supported by the placenta or the umbilical cord. 6 Vasa previa is most effectively diagnosed by transvaginal ultrasound using color Doppler, 7 which has been shown to have sensitivity, specificity, and positive and negative predictive values of 100%, 99.8%, 83%, and 100% respectively.…”