Vasa previa: prenatal diagnosis and management

Melcer, Yaakov; Maymon, Ron; Jauniaux, Eric

doi:10.1097/gco.0000000000000478

Cited by 21 publications

(19 citation statements)

References 37 publications

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“…Interestingly, approximately 85% of cases of vasa previa have one or more identifiable risk factors, including multiple gestations, in-vitro fertilization, bilobed, multilobed, succenturiate-lobed, low-lying placentas, and velamentous insertion of the umbilical cord. 132,134,143 Approximately 11% of cases are without existing risk factors. 144 In a multicenter study of 155 pregnancies complicated by the presence of vasa previa, Oyelese et al reported an overall perinatal mortality of 36% (55/155).…”

Section: Dovepressmentioning

confidence: 99%

“…Despite the absence of sufficient evidence to support the universal mid-gestation ultrasound screening, recent data indicate the need for standardized prenatal targeted screening protocols for patients at increased risk of vasa previa. 138 , 140 , 143 Ranzini and Oyelese recently stressed the three steps necessary for screening for vasa previa. 140 Detailed assessment of the umbilical cord insertion site.…”

Section: Structural Abnormalities Of the Umbilical Cordmentioning

confidence: 99%

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Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

Sherer¹,

Al-Haddad²,

Cheng³

et al. 2021

IJWH

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The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton's jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl's anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.

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Section: Dovepressmentioning

confidence: 99%

Section: Structural Abnormalities Of the Umbilical Cordmentioning

confidence: 99%

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

Sherer¹,

Al-Haddad²,

Cheng³

et al. 2021

IJWH

View full text Add to dashboard Cite

show abstract

“…The variant of abnormal placenta that is correlated with the most adverse obstetric outcomes is vasa previa [ 1 , 2 , 3 , 4 ], which is characterized by unprotected cord vessels running near or across the internal cervical os [ 1 , 2 , 5 , 6 ]. The distance between the unprotected cord vessels and internal cervical os used to diagnose vasa previa is controversial, and fetal blood vessels running within 2 cm of the internal cervical os are recognized as vasa previa [ 7 , 8 , 9 , 10 ].…”

Section: General Overviewmentioning

confidence: 99%

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

et al. 2022

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Vasa previa is a rare fetal life-threatening obstetric disease classified into types I and II. This study aimed to examine the characteristics and obstetric outcomes of type II vasa previa. A systematic review was performed, and 20 studies (1998–2022) were identified. The results from six studies showed that type II vasa previa accounted for 21.3% of vasa previa cases. The characteristics and obstetric outcomes (rate of assisted reproductive technology (ART), antenatal diagnosis, emergent cesarean delivery, maternal transfusion, gestational age at delivery, and neonatal mortality) were compared between type I and II vasa previa, and all outcomes of interest were similar. The association between ART and abnormal placenta (bilobed placenta or succenturiate lobe) was examined in three studies, and the results were as follows: (i) increased rate of succenturiate lobes (ART versus non-ART pregnancy; OR (odds ratio) 6.97, 95% confidence interval (CI) 2.45–19.78); (ii) similar rate of abnormal placenta (cleavage-stage versus blastocyst embryo transfer); (iii) increased rate of abnormal placenta (frozen versus fresh embryo transfer; OR 2.97, 95%CI 1.10–7.96). Although the outcomes of type II vasa previa appear to be similar to those of type I vasa previa, the current evidence is insufficient for a robust conclusion.

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“…Pregnancies conceived by ART and in particular by IVF have consistently been associated with a higher incidence of abnormal cord insertion. As cesarean deliveries increase the incidence of placenta previa 2,6 in subsequent pregnancies and IVF increases the risk of placental anomalies, 1 multiple pregnancies 39,40 and velamentous cord insertion, 12 the incidence of vasa previa is likely to increase.…”

Section: Vasa Previamentioning

confidence: 99%