Placental Types and Effective Perinatal Management of Vasa Previa: Lessons from 55 Cases in a Single Institution

Abstract

Background: We aimed to identify clinical characteristics and outcomes for each placental type of vasa previa (VP). Methods: Placental types of vasa previa were defined as follows: Type 1, vasa previa with velamentous cord insertion and non-type 1, vasa previa with a multilobed or succenturiate placenta and vasa previa with vessels branching out from the placental surface and returning to the placental cotyledons. Results: A total of 55 cases of vasa previa were included in this study, with 35 cases of type 1 and 20 cases of non-type 1. Vasa previa with type 1 showed a significantly higher association with assisted reproductive technology, compared with non-type 1 (p = 0.024, 60.0% and 25.0%, respectively). The diagnosis was significantly earlier in the type 1 group than in the non-Type 1 group (p = 0.027, 21.4 weeks and 28.6 weeks, respectively). Moreover, the Ward technique for anterior placentation to avoid injury of the placenta and/or fetal vessels was more frequently required in non-type 1 cases (p < 0.001, 60.0%, compared with 14.3% for type 1). Conclusion: The concept of defining placental types of vasa previa will provide useful information for the screening of this serious complication, improve its clinical management and operative strategy, and achieve more preferable perinatal outcomes.

The Characteristics and Obstetric Outcomes of Type II Vasa Previa: Systematic Review and Meta-Analysis

“…Figure 1 shows the selection scheme used in this study. First, 1364 studies were identified, and 20 studies met the study criteria for descriptive analysis [ 14 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Two studies reported by Suzuki et al [ 36 , 37 ] used overlapped data (due to overlapping study periods); however, the outcome of interest was different in these studies.…”

“…Regarding the study type ( n = 20), all studies were retrospective in nature, 14 were original articles, 4 were case series, and 2 were case reports. Of these ( n = 20), the published years were between 1998 and 2022, and all studies were retrospective [ 14 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. No prospective studies or randomized controlled trials have been reported.…”

“…Among the eligible studies ( n = 20), approximately one-third were reported from Europe ( n = 6, 30.0%) [ 38 , 41 , 44 , 45 , 46 , 51 ] followed by Japan ( n = 5, 25.0%) [ 36 , 37 , 39 , 47 , 48 ], the United States ( n = 5, 25.0%) [ 14 , 35 , 43 , 49 , 52 ], and others ( n = 4, 20.0%) [ 34 , 40 , 42 , 50 ].…”

“…The risk of bias assessment for the included comparator studies is presented in Supplemental Table S2 . Among the studies ( n = 6), a possible moderate publication bias in three studies [ 40 , 42 , 43 ] and severe publication bias in the other three studies [ 39 , 41 , 44 ] were observed.…”

“…A systematic review was performed to identify previous studies that included women with type II vasa previa, and 16 studies met the criteria ( Table 1 ) [ 14 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Of these ( n = 16), seven studies were original articles, six were case series, and the remaining three studies were case reports.…”