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Vasa previa: diagnosis and management
Morgan L Swank1, Thomas J Garite2, Kimberly Maurel3
1University of California, Irvine Medical Center, Orange, CA.
American Journal of Obstetrics and Gynecology
|March 6, 2016
Summary
Vasa previa diagnosis and management have improved neonatal outcomes. Antenatal ultrasound screening and timely interventions significantly reduce fetal and neonatal mortality in vasa previa (VP) cases.
Area of Science:
- Maternal-Fetal Medicine
- Obstetrics
- Neonatology
Background:
- Vasa previa (VP) is a rare obstetric condition with high fetal/neonatal mortality if not diagnosed antenatally.
- Existing studies on VP are limited by small sample sizes, lack of antepartum data, single-institution focus, or registry/support group bias.
Purpose of the Study:
- To investigate diagnostic and management strategies for vasa previa.
- To identify maternal and placental risk factors to aid in developing a screening protocol for vasa previa.
Main Methods:
- Retrospective, multicenter descriptive study of pregnancies with vasa previa delivering between 2000 and 2012.
- Data collected from nine maternal-fetal medicine practices, including diagnosis, treatment, and maternal-neonatal outcomes.
- Included 68 pregnancies diagnosed with vasa previa or possible vasa previa.
Main Results:
- Vasa previa was diagnosed antenatally via ultrasound in 96% of 49 confirmed cases.
- Known risk factors were present in 87% of confirmed cases.
- Planned cesarean delivery occurred in 41 cases (mean gestational age 34.7 weeks); 8 required emergent cesarean delivery (mean gestational age 34.6 weeks) primarily for bleeding, with one undiagnosed case resulting in severe neonatal morbidity.
Conclusions:
- Current recommendations for risk-based ultrasound screening, early hospitalization (30-34 weeks), antenatal corticosteroids (30-32 weeks), and elective delivery (33-34 weeks) are confirmed.
- These strategies have dramatically improved neonatal survival and reduced complications compared to historical data.
- Geographically diverse, private practice settings demonstrate the effectiveness of established protocols for vasa previa management.
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