Natural history of vasa previa across gestation using a screening protocol

Andrei Rebarber, Cara Dolin, Nathan S. Fox, Chad K. Klauser, Daniel H. Saltzman, Ashley S. Roman

Research output: Contribution to journalArticlepeer-review

53 Scopus citations

Abstract

Objectives-The purpose of this study was to estimate the prevalence and persistence rate of vasa previa in at-risk pregnancies using a standardized screening protocol. Methods-We conducted a descriptive study of patients with a diagnosis of vasa previa from a single ultrasound unit between June 2005 and June 2012. Vasa previa was defined as a fetal vessel within 2 cm of the internal cervical os on transvaginal sonography. Screening for vasa previa using transvaginal sonography with color flow mapping was performed routinely in the following situations: resolved placenta previa, prior pregnancy with vasa previa, velamentous insertion of the cord in the lower uterine segment, placenta succenturiata in the lower uterine segment, and twin gestations. Results-A total of 27,573 patients were referred to our unit for fetal anatomic surveys over the study period. Thirty-one cases of vasa previa were identified, for an incidence of 1.1 per 1000 pregnancies. Twenty-nine cases had full records available for analysis. Five patients (17.2%) had migration and resolution of the vasa previa. When the diagnosis was made during the second trimester (<26 weeks), there was a 23.8% resolution rate (5 of 21); when the diagnosis was made in the third trimester, none resolved (0 of 8 cases). Of the 24 pregnancies (5 twin gestations and 19 singleton gestations) with persistent vasa previa, there was 100% perinatal survival and a median length of gestation of 35 weeks (range, 27 weeks 5 days-36 weeks 5 days). No known missed cases were identified over the study period. Conclusions-The use of standardized screening for vasa previa based on focused criteria was found to be effective in diagnosing vasa previa, with a 100% survival rate. Vasa previa diagnosed during the second trimester resolves in approximately 25% of cases.

Original languageEnglish
Pages (from-to)141-147
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume33
Issue number1
DOIs
StatePublished - 1 Jan 2014

Keywords

  • Obstetric ultrasound
  • Prenatal diagnosis
  • Vasa previa migration
  • Vasa previa screening

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