Accessible Requires Authentication Published by De Gruyter May 4, 2021

Vasa previa: when antenatal diagnosis can change fetal prognosis

Miriam Sutera, Anna Garofalo ORCID logo, Eleonora Pilloni, Silvia Parisi, Maria Grazia Alemanno, Guido Menato, Andrea Sciarrone and Elsa Viora

Abstract

Objectives

Evaluate ultrasound diagnostic accuracy, maternal−fetal characteristics and outcomes in case of vasa previa diagnosed antenatally, postnatally or with spontaneous resolution before delivery.

Methods

Monocentric retrospective study enrolling women with antenatal or postnatal diagnosis of vasa previa at Sant’Anna Hospital in Turin from 2007 to 2018. Vasa previa were defined as fetal vessels that lay 2 cm within the uterine internal os using 2D and Color Doppler transvaginal ultrasound. Diagnosis was confirmed at delivery and on histopathological exam. Vasa previa with spontaneous resolutions were defined as fetal vessels that migrate >2 cm from uterine internal os during scheduled ultrasound follow-ups in pregnancy.

Results

We enrolled 29 patients (incidence of 0.03%). Ultrasound antenatally diagnosed 25 vasa previa (five had a spontaneous resolution) while four were diagnosed postnatally, with an overall sensitivity of 96.2%, specificity of 100%, positive predictive value of 96.2%, and negative predictive value of 100%. Early gestational age at diagnosis is significally associate with spontaneously resolution (p 0.023; aOR 1.63; 95% IC 1.18–2.89). Nearly 93% of our patient had a risk factor for vasa previa: placenta previa at second trimester or low-lying placenta, bilobated placenta, succenturiate cotyledon, velametous cord insertion or assisted reproduction technologies.

Conclusions

Maternal and fetal outcomes in case of vasa previa antenatally diagnosed are significally improved. Our data support the evaluation of umbilical cord insertion during routine second trimester ultrasound and a targeted screening for vasa previa in women with risk factor: it allows identification of fetus at high risk, reducing fetal mortality in otherwise healthy newborns.


Corresponding author: Anna Garofalo, Gynecology and Obstetrics Unit, Prenatal Diagnosis Ultrasound Center, Sant’Anna Hospital, Città della Salute e della Scienza, University of Turin, Via Ventimiglia 3 Turin, Italy, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board approved the study.

References

1. Jauniaux, ER, Alfirevic, Z, Bhide, AG, Burton, GJ, Collins, SL, Silver, R. Vasa praevia: diagnosis and management. Green-top guideline no. 27b. BJOG 2019;126:e49-61. https://doi.org/10.1111/1471-0528.15307. Search in Google Scholar

2. Oyelese, Y, Catanzarite, V, Prefumo, F, Lashley, S, Schachter, M, Tovbin, Y, et al.. Vasa previa: the impact of prenatal diagnosis on outcomes. Obstet Gynecol 2004;103:937–42. https://doi.org/10.1097/01.aog.0000123245.48645.98. Search in Google Scholar

3. Hasegawa, J, Nakamura, M, Ichizuka, K, Matsuoka, R, Sekizawa, A, Okai, T. Vasa previa is not infrequent. J Matern Fetal Neonatal Med 2012;25:2795–6. https://doi.org/10.3109/14767058.2012.712570. Search in Google Scholar

4. Ruiter, L, Kok, N, Limpens, J, Derks, JB, De Graaf, IM, Mol, BW, et al.. Systematic review of accuracy of ultrasound in the diagnosis of vasa previa. Ultrasound Obstet Gynecol 2015;45:516–22. https://doi.org/10.1002/uog.14752. Search in Google Scholar

5. Melcer, Y, Maymon, R, Jauniaux, ER. Vasa previa: prenatal diagnosis and management. Curr Opin Obstet Gynecol 2018;30:385–91. https://doi.org/10.1097/gco.0000000000000478. Search in Google Scholar

6. Swank, ML, Garite, TJ, Maurel, K, Das, A, Perlow, JH, Combs, CA, et al., Obstetric Collaborative Research Network. Vasa previa: diagnosis and management. Am J Obstet Gynecol 2016;215:223.e1–6.e1. https://doi.org/10.1016/j.ajog.2016.02.044. Search in Google Scholar

7. Cipriano, LE, Barth, WH, Zaric, GS. The cost-effectiveness of targeted or universal screening for vasa praevia at 18–20 weeks of gestation in Ontario. BJOG 2010;117:1108–18. https://doi.org/10.1111/j.1471-0528.2010.02621.x. Search in Google Scholar

8. Oyelese, Y, Smulian, JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006;107:927–41. https://doi.org/10.1097/01.aog.0000207559.15715.98. Search in Google Scholar

9. Kulkarni, A, Powel, J, Aziz, M, Shah, L, Lashley, S, Benito, C, et al.. Vasa previa: prenatal diagnosis and outcomes: thirty-five cases from a single maternal-fetal medicine practice. J Ultrasound Med 2018;37:1017–24. https://doi.org/10.1002/jum.14452. Search in Google Scholar

10. Sullivan, EA, Javid, N, Duncombe, G, Li, Z, Safi, N, Cincotta, R, et al.. Vasa previa diagnosis, clinical practice, and outcomes in Australia. Obstet Gynecol 2017;130:591–8. https://doi.org/10.1097/aog.0000000000002198. Search in Google Scholar

11. Nishtar, A, Wood, PL. Is it time to actively look for vasa praevia? J Obstet Gynaecol 2012;32:413–8. https://doi.org/10.3109/01443615.2012.673038. Search in Google Scholar

12. Ruiter, L, Kok, N, Limpens, J, Derks, JB, De Graaf, IM, Mol, BW, et al.. Incidence of and risk indicators for vasa praevia: a systematic review. BJOG 2016;123:1278–87. https://doi.org/10.1111/1471-0528.13829. Search in Google Scholar

13. Jauniaux, E, Melcer, Y, Maymon, R. Prenatal diagnosis and management of vasa previa in twin pregnancies: a case series and systematic review. Am J Obstet Gynecol 2017;216:568–75. https://doi.org/10.1016/j.ajog.2017.01.029. Search in Google Scholar

14. Smorgick, N, Tovbin, Y, Ushakov, F, Vaknin, Z, Barzilay, B, Herman, A, et al.. Is neonatal risk from vasa previa preventable? The 20-year experience from a single medical center. J Clin Ultrasound 2010;38:118–22. https://doi.org/10.1002/jcu.20665. Search in Google Scholar

15. Rebarber, A, Dolin, C, Fox, NS, Klauser, CK, Saltzman, DH, Roman, AS. Natural history of vasa previa across gestation using a screening protocol. J Ultrasound Med 2014;33:141–7. https://doi.org/10.7863/ultra.33.1.141. Search in Google Scholar

16. Catanzarite, V, Maida, C, Thomas, W, Mendoza, A, Stanco, L, Piacquadio, KM. Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol 2001;18:109–15. https://doi.org/10.1046/j.1469-0705.2001.00448.x. Search in Google Scholar

17. No, GR. 231-Guidelines for the management of vasa previa. J Obstet Gynaecol Can 2017;39:e415–21. Search in Google Scholar

18. Young, M, Yule, N, Barham, K. The role of light and sound technologies in the detection of vasa praevia. Reprod Fertil Dev 1991;3:439–45. https://doi.org/10.1071/rd9910439. Search in Google Scholar

19. Catanzarite, V, Cousins, L, Daneshmand, S, Schwendemann, W, Casele, H, Adamczak, J, et al.. Prenatally diagnosed vasa previa: a single-institution series of 96 cases. Obstet Gynecol 2016;128:1153–61. https://doi.org/10.1097/aog.0000000000001680. Search in Google Scholar

20. Bronsteen, R, Whitten, A, Balasubramanian, M, Lee, W, Lorenz, R, Redman, M, et al.. Vasa previa: clinical presentations, outcomes, and implications for management. Obstet Gynecol 2013;122:352–7. https://doi.org/10.1097/aog.0b013e31829cac58. Search in Google Scholar

21. Society of Maternal-Fetal (SMFM) Publications Committee, Sinkey, RG, Odibo, AO, Dashe, JS. #37: diagnosis and management of vasa previa. Am J Obstet Gynecol 2015;213:615–9. https://doi.org/10.1016/j.ajog.2015.08.031. Search in Google Scholar

22. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med 2013;32:1083–101. https://doi.org/10.7863/ultra.32.6.1083. Search in Google Scholar

23. Ioannou, C, Wayne, C. Diagnosis and management of vasa previa: a questionnaire survey. Ultrasound Obstet Gynecol 2010;35:205–9. https://doi.org/10.1002/uog.7466. Search in Google Scholar

24. Gagnon, R, Morin, L, Bly, S, Butt, K, Cargill, YM, Denis, N, et al.. Sogc clinical practice guideline: guidelines for the management of vasa previa. Int J Gynaecol Obstet 2010;108:85–9. https://doi.org/10.1016/j.ijgo.2009.09.011. Search in Google Scholar

25. Golic, M, Hinkson, L, Bamberg, C, Rodekamp, E, Brauer, M, Sarioglu, N, et al.. Vasa praevia: risk-adapted modification of the conventional management—a retrospective study. Ultraschall Med 2013;34:368–76. https://doi.org/10.1055/s-0032-1313167. Search in Google Scholar

26. Sepulveda, W, Rojas, I, Robert, JA, Schnapp, C, Alcalde, JL. Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study. Ultrasound Obstet Gynecol 2003;21:564–9. https://doi.org/10.1002/uog.132. Search in Google Scholar

27. Nomiyama, M, Toyota, Y, Kawano, H. Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging. Ultrasound Obstet Gynecol 1998;12:426–9. https://doi.org/10.1046/j.1469-0705.1998.12060426.x. Search in Google Scholar

28. Hasegawa, J, Arakaki, T, Ichizuka, K, Sekizawa, A. Management of vasa previa during pregnancy. J Perinat Med 2015;43:783–4. https://doi.org/10.1515/jpm-2014-0047. Search in Google Scholar

29. Robinson, BK, Grobman, WA. Effectiveness of timing strategies for delivery of individuals with vasa previa. Obstet Gynecol 2011;117:542–9. https://doi.org/10.1097/aog.0b013e31820b0ace. Search in Google Scholar

30. Eddleman, KA, Lockwood, CJ, Berkowitz, GS, Lapinski, RH, Berkowitz, RL. Clinical significance and sonographic diagnosis of velamentous umbilical cord insertion. Am J Perinatol 1992;9:123–6. https://doi.org/10.1055/s-2007-994684. Search in Google Scholar

Received: 2020-11-26
Accepted: 2021-04-14
Published Online: 2021-05-04
Published in Print: 2021-09-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston