Second trimester low-lying placenta and in-vitro fertilization? Exclude vasa previa

Oyelese, Yinka; Spong, Catherine Y.; Fernández, Miguel Ángel Luque; McLaren, Rodney

doi:10.1002/1520-6661(200011/12)9:6<370::aid-mfm1011>3.0.co;2-e

Cited by 22 publications

(10 citation statements)

References 4 publications

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“…The prevalence of vasa previa is 1 in 2500 deliveries with risk factors including use of assisted reproductive technologies [2][3][4]10], placenta previa, bilobed or succenturinate lobe and multiple gestations [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion

Baumfeld

Gutvirtz

Shoham

et al. 2015

Arch Gynecol Obstet

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Section: Introductionmentioning

confidence: 99%

Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion

Baumfeld

Gutvirtz

Shoham

et al. 2015

Arch Gynecol Obstet

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“…The incidence of vasa previa has been reported to be as high as 1 in 202 after IVF compared with 1 in 2200 in non-IVF pregnancies, with a likelihood ratio of 7.75 [3,5,13]. Other significant risk factors for vasa previa include second trimester placenta previa, with an odds ratio of 22.86, and bilobed and succenturiate-lobed placentas, with an odds ratio of 22.11 [5].…”

Section: Discussionmentioning

confidence: 99%

“…• those with a second-trimester low-lying placenta or placenta previa even if it has resolved; • pregnancies conceived after use of assisted reproductive technologies; and • patients with bilobed and succenturiate lobe placentas in the lower uterine segment [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

A case of vasa previa diagnosed prenatally, and review of the literature

et al. 2010

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The perinatal mortality rate of vasa previa is high if it is not prenatally diagnosed. In this report, a case of vasa previa diagnosed prenatally is presented. Antepartum hemorrhage at 24 weeks of gestation prompted a close investigation of the uterine cervix, internal os, and placenta. We detected a low-lying bilobed placenta with umbilical cord insertion in the lower uterine segment. Furthermore, one of the connecting vessels of the bilobed placenta passed directly above the internal os. Vasa previa was suspected and confirmed with color Doppler and MRI. The fetus was delivered uneventfully by planned Cesarean section at 38 weeks of gestation. It should be considered that placenta previa (including low-lying placenta), bilobed placenta, and umbilical cord insertion in the lower uterine segment are associated with high risk of vasa previa. Ultrasound screening for cord insertion and placenta around the internal os enables efficient and certain detection of vasa previa.

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“…Low-lying placenta in the second trimester is an important independent risk factor regardless of whether it does persist at term [10,12,15,16]. Up to 60% of women with vasa praevia have a low-lying placenta in the second trimester; in only one third of these, the placenta will remain low lying until delivery [1,16].…”

Section: Diagnosismentioning

confidence: 99%

“…The cause is unclear, although the previously described placental abnormalities are more commonly linked to IVF, as are multiple pregnancies [15,17].…”

Section: Diagnosismentioning

confidence: 99%

Vasa praevia: a lethal threat to the fetus

Ameryckx

Amy

2006

Eur Clinics Obstet Gynaecol

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Vasa praevia constitutes a rare obstetric complication that is potentially lethal for the generally healthy infant. If unrecognized antenatally, the condition carries a higher fetal mortality rate than any other complication in pregnancy. Only in the past two decades have major diagnostic advances led to a dramatic improvement of perinatal survival and lower morbidity rates. Good outcomes depend primarily on prenatal diagnosis and appropriate management. The performance of a caesarean section before rupture of the membranes and the onset of labour is mandatory. Simple modifications of standard screening protocols and the recognition of high-risk patients will allow identification of most cases of vasa praevia. DefinitionIn normal circumstances, the umbilical cord is inserted into the chorionic plate (fetal surface) of the placenta (central or, more frequently, eccentric insertion) or on the placental edge (marginal insertion). The umbilical cord vessels course over the fetal surface before entering the placenta. In about 1% of singleton and 10% of twin pregnancies, however, the umbilical cord vessels separate from each other and start branching at a distance from the placental margin; they run through the membranes, surrounded only by a fold of amnion, before reaching the chorionic plate. If this so-called velamentous insertion is situated in the lower uterine segment, and the unprotected fetal vessels cross the region of the internal cervical os below the presenting fetal part, one speaks of vasa praevia. This aberrant vasculature can also be associated with bilobed or succenturiate placentas, in which case the vessels run between the accessory lobes.Vasa praevia is encountered rarely (1 of 2,500-5,000 deliveries), but even today they are associated with high fetal mortality (∼60%) and morbidity if undiagnosed antenatally [1]. The unprotected umbilical vessels are exposed to compression or rupture, especially during labour or at the time of rupture of the membranes. Laceration of the vasa praevia can rapidly lead to fetal exsanguination, shock (after as little as 60-ml blood loss, corresponding to 20-25% of the feto-placental blood volume) and intrauterine death. The fetus, indeed, has only a small circulatory volume of 80-100 ml/kg. The mother, on the other hand, is not at risk, in contrast to haemorrhages resulting from placenta praevia or abruptio placentae. AetiologySome placentas implant over the uterine isthmus or even over the internal cervical os. Due to the development of the lower uterine segment during the third trimester, the placenta appears to "move away" from the cervical region. The placenta preferentially grows in the better vascularised area of the corpus and may undergo atrophy in the lower parts of the uterus [2]. During this process, an aberrant vessel can persist over or close to the cervix. In cases where the placenta overlies the less vascularised internal os, it may undergo atrophy, which results in the development of a succenturiate lobe and connecting vasa praevia. Beside the aforement...

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Second trimester low-lying placenta and in-vitro fertilization? Exclude vasa previa

Cited by 22 publications

References 4 publications

Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion

Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion

A case of vasa previa diagnosed prenatally, and review of the literature

Vasa praevia: a lethal threat to the fetus

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