Vasa Previa: Maternal and Early Neonatal Outcomes in the New Era of Obstetrical Care [13K]

Abstract

INTRODUCTION: Report on one institution's experience with diagnosis, management, and outcomes in vasa previa cases. METHODS: Retrospective study of all pregnancies referred to two tertiary hospitals from 2010 to 2016 for suspicion or high risk for vasa previa. Medical records and imaging were reviewed by multiple authors to confirm diagnosis and assess outcomes. RESULTS: 408 pregnant women were referred for evaluation of suspected vasa previa. 380 (93%) were not diagnosed with vasa previa after ultrasonography. Of the 28 confirmed cases, 20 (71%) and 8 (29%) were diagnosed as Type 1 and Type 2 vasa previa respectively. In 9 (32%) women, vasa previa resolved spontaneously after a mean 5.8 plus or minus 3.9 weeks. Unresolved cases were diagnosed on average at 25.9 plus or minus 5.2 weeks. Delivery occurred at 33.4 plus or minus 2.9 weeks on average. 13 (68%) neonates from unresolved vasa previa cases required NICU admission. Neonates had an average 5 minute Apgar score of 9. Only 1 fetus expired, but death was attributable to complications from a pericardial teratoma prior to delivery. One Type 2 case received antepartum laser obliteration of fetal vessels that successfully prolonged pregnancy. Average maternal blood loss was 860 plus or minus 56 cc with no ICU admissions or maternal deaths. CONCLUSION: In this large series, we display the continued improved maternal and neonatal outcomes in vasa previa. In equipped centers, physicians are able to successfully manage and deliver fetuses with careful antepartum attention. Furthermore, one case's treatment with laser ablation suggests a possible intervention in some presentations.

Timing of birth and adverse pregnancy outcomes in cases of prenatally diagnosed vasa previa: a systematic review and meta-analysis

“…The most commonly reported outcomes included perinatal mortality, 4,7,[12][13][14]18,19,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][48][49][50][51][52] respiratory distress syndrome (RDS) requiring intubation, 12,14,27,30,33,34,[36][37][38]40,41,46 5-minute Apgar scores <7, 1,2,12,14,18,19,[27]…”