Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia

Sullivan, Elizabeth A.; Javid, Nasrin; Duncombe, Gregory; Li, Zhuoyang; Safi, Nadom; Cincotta, Robert; Homer, Caroline; Halliday, Lesley E.; Oyelese, Yinka

doi:10.1097/aog.0000000000002198

Cited by 65 publications

(107 citation statements)

References 19 publications

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“…Vasa previa will accompany 1 per 13 velamentous cord insertions, resulting in a mean vasa previa incidence of 0.6 per 1000 pregnancies . Identification of a velamentous cord insertion, seen in up to 62% of vasa previas, should lead to an ultrasound evaluation for vasa previa …”

Section: The Rationale For Imaging the Placental Cord Insertion Sitementioning

confidence: 99%

Imaging the Placental Cord Insertion: Just Do It

Wax

Pinette

2019

J of Ultrasound Medicine

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Section: The Rationale For Imaging the Placental Cord Insertion Sitementioning

confidence: 99%

Imaging the Placental Cord Insertion: Just Do It

Wax

Pinette

2019

J of Ultrasound Medicine

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“…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…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of VP has been reported as 1 per 1600–5000 deliveries . This low prevalence means the positive predictive value of universal screening is likely to be poor, and there is the potential to do harm through unnecessary interventions such as corticosteroid administration, hospital admission, and iatrogenic preterm cesarean delivery.…”

Section: Introductionmentioning

confidence: 99%

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

Javid

Hyett

Walker

et al. 2019

Intl J Gynecology & Obste

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Objectives To define current obstetric opinion and clinical practice regarding the prenatal diagnosis of vasa previa in Australia and New Zealand. Methods A population‐based cross‐sectional survey of Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists was conducted from April to May, 2016. Descriptive analysis was used to define factors influencing opinion and practice regarding definition of vasa previa, attributable risk factors, and the value of screening. Results Overall, 453 respondents were included in the study. Two‐thirds (304/453; 67.1%) defined vasa previa as exposed fetal vessel(s) running over or within 2 cm of the internal os. A higher proportion of ultrasound specialists (30/65; 46.2%) preferred a broader definition as compared with generalists (115/388; 29.6%; P<0.001). Overall, Fellows were supportive (342/430; 79.5%) of both reporting ultrasound‐based risk factors at the 20‐week anomaly scan and targeted screening (298/430; 69.3%). Only 77/453 (17.0%) respondents recognized all five “known” risk factors for vasa previa. Conclusions There was a lack of consensus regarding the definition and diagnosis process for vasa previa. There was also a knowledge gap in risk factors for vasa previa that would inform a targeted screening policy. Nevertheless, support for targeted screening was strong from obstetricians who responded.

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“…In September 2017, Sullivan et al published the AMOSS (Australasian Maternity Outcomes Surveillance Systems) study. They highlighted that between May 1, 2013 and April 30, 2014 there were 63 cases of confirmed vasa praevia in Australia with 51 (88%) of women diagnosed through ultrasound and five (8%) cases being missed on ultrasound and diagnosed only during labour . In the beginning of 2018 two patients presented to our institution in their third trimester with antepartum haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

“…Vasa praevia is a silent condition with potentially fatal consequences for the fetus. It is defined as fetal vessels (unsupported by either the Wharton's jelly in the umbilical cord or placental tissue) that run through the amniotic membranes in close proximity to or overlying the cervix . The estimated incidence of vasa praevia is 1:1250 – 1:4667 pregnancies .…”

Section: Introductionmentioning

confidence: 99%

Detection of vasa praevia in the mid‐trimester ultrasound by Australian sonographers

et al. 2019

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Objective To ascertain Australian obstetric sonographers knowledge and current practice when assessing for vasa praevia in the mid‐trimester ultrasound with the view to improve prenatal diagnosis. Methods Between August and September 2018, a survey was emailed to 4868 Australian sonographers registered to participate in Australian Sonography Association Registry (ASAR) facilitated research projects. A total of 577 responses were received. The sonographers survey response was compared with published Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) recommendations. Results There appears to be an unfamiliarity with the RANZCOG recommendations, in particular that vasa praevia is defined as a fetal vessel lying within 20 mm of the cervical internal os (IOS). Transabdominally, if a vasa praevia risk factor is identified (including a fetal vessel observed in the lower uterine segment), less than 48% of surveyed sonographers proceed to a targeted transvaginal scan. Conclusion To enable effective diagnosis of vasa praevia, it is important to recognise associated risk factors that can raise suspicion for a potential vasa praevia; these are velamentous cord insertion, succenturiate lobe, and low‐lying placenta. A lower threshold of performing a transvaginal ultrasound when risk factors are identified (including a fetal vessel is identified in the lower uterine segment) may significantly improve vasa praevia diagnosis in the mid‐trimester ultrasound.

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Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia

Abstract: The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.

Cited by 65 publications

References 19 publications

Imaging the Placental Cord Insertion: Just Do It

Imaging the Placental Cord Insertion: Just Do It

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

Detection of vasa praevia in the mid‐trimester ultrasound by Australian sonographers

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