Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review

Abstract

Word count: 3208Condensation: Management strategies in twin pregnancies presenting with vasa praevia should be tailored on the basis of chorionicity and changes in cervical length. Short title: Management of vasa previa in twinsKey Words: Velamentous; umbilical cord; vasa previa; twins; placenta. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 2 Abstract Background: Twin pregnancies are at higher risks of velamentous cord *Manuscript Click here to view linked References

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

“…From 2008, all asymptomatic women presenting with VP were followedup with transvaginal ultrasound for cervical length and VP position every 2 weeks from the time of the first diagnosis of VP until delivery. 17 The timing of delivery was scheduled according to changes in cervical length and/or clinical symptoms (mainly uterine contractions and/or vaginal bleeding), following a course of corticosteroids.…”

“…When the cervical remains stable with normal fetal development and there are no clinical symptoms delivery was planned at 35-36 weeks' gestation. 17 Before implementation of the scanning protocols, cases had to be recovered from medical records whereas all cases post-implementation of the protocols were…”

“…16 The prenatal ultrasound diagnosis of VP using transvaginal sonography (TVS) and colour Doppler imaging (CDI) is highly accurate and specific. 2,17 There is increasing evidence that multidisciplinary team (MDT) management of pregnancies with suspected PAS is superior to standard obstetric care 18,19 and prenatal diagnosis of VP has been shown to improve the case perinatal survival rates to 95%. 16,21 We have developed targeted scanning protocols for both PAS and VP including clinical risk factors and ultrasound scoring system for PAS.…”

Vasa Praevia: Diagnosis and Management

“…Similarly, data from a 2017 systematic review on the management of vasa praevia in twins have indicated that TVS cervical length measurements from 26-28 weeks of gestation may be useful to evaluate the individual risk of preterm birth. 34…”

Histopathological examination of the placenta in twin pregnancies

“…When first received, it is important to be able to identify the twins; while in theory, the first delivered twin (twin 1) and second delivered twin (twin 2) can be identified from examination of the membranes [the opening from the sac of twin 1 will be through the free membranes, while the opening from the sac of twin 2 will be through the dividing membrane into the sac of twin 1], the frequency of Cesarean section and of artifactual tearing of the membranes makes it more reliable to have an agreed cord labeling protocol with the local obstetricians. As the frequency of velamentous cord insertion and vasa previa is increased in twin pregnancy , the initial examination of the membranes should carefully document velamentous cord insertions and document by photography whether vessels running through membranes are intact or otherwise, especially when they run close to the membrane rupture site. If velamentous vessels are disrupted, it is prudent to determine if there was any clinical evidence of fetal hemorrhage from vasa previa; in these cases, gross photography is the most valuable method to document the ruptured vessel, its relationship with the membrane opening, and any hemorrhage into adjacent membranes.…”