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Guidelines for the Management of VasaPrevia No. 231-Guidelines for the Management of VasaPrevia - Journal of Obstetrics and Gynaecology Canada Email/Username: Password: Remember me Search Terms Search within Search Volume 39, Issue 10, Pages e415–e421 No. 231-Guidelines for the Management of VasaPrevia x Robert Gagnon , MD (Principal Author) Montréal, QC No. 231 (Reaffirmed October 2017) DOI: To view the full text, please login as a subscribed user or . Click to view the full text (...) on ScienceDirect. Abstract Objectives To describe the etiology of vasaprevia and the risk factors and associated condition, to identify the various clinical presentations of vasaprevia, to describe the ultrasound tools used in its diagnosis, and to describe the management of vasaprevia. Outcomes Reduction of perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short-term and long-term maternal morbidity and mortality. Evidence Published literature on randomized trials
VasaPrevia Diagnosis, Clinical Practice, and Outcomes in Australia To estimate the incidence of women with vasaprevia in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed (...) with vasaprevia during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.Sixty-three women had a confirmed diagnosis of vasaprevia. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7-2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasaprevia
Is there any role for fetoscopic laser ablation therapy in type-2 vasaprevia? Here we reviewed the literature regarding an interesting new approach to treat type 2 vasaprevia (VP). Vasaprevia is a rare placental disorder in which fetal blood vessels, unsupported by underlying placenta, cross over the cervical internal os; type 1 vasaprevia is attributed to a velamentous cord insertion near the cervix while type 2 vasaprevia occurs when connecting vessels of a bi or multilobed placenta (...) cross over internal cervical 1 . To date, there have been 5 reported cases of fetoscopic laser ablation for the treatment of type 2 vasaprevia between 22 and 33 weeks' gestation 2-5 . Treatment was indicated due to the presence of premature contractions or progressive cervical shortening in two patients 3,5 This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
Impact of Targeted Scanning Protocols on Perinatal Outcomes in Pregnancies at Risk of Placenta Accreta Spectrum or VasaPrevia. Placenta accreta spectrum and vasaprevia (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes.The objective of the study was to compare (...) perinatal outcome in women with placenta accreta spectrum or vasaprevia before and after implementation of targeted scanning protocols.This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004-1012 vs 2013-2016 for placenta accreta spectrum and 1988-2007 vs 2008-2016 for vasaprevia). Clinical reports of women diagnosed with placenta accreta spectrum and vasaprevia during the study periods were reviewed
Four-dimensional spatiotemporal image correlation (4D-STIC) sonographic diagnosis of vasaprevia. Vasaprevia is a rare condition; it occurs in approximately 1:2500 deliveries. Fetal blood vessels, unsupported by placental tissues or umbilical cord, run through the fetal membrane over the internal cervical os below the presenting segment.1 This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.
Vasaprevia: prenatal diagnosis and management. Vasaprevia is a rare disorder of placentation associated with a high rate of perinatal morbidity and mortality when undetected before delivery. We have evaluated the recent evidence for prenatal diagnosis and management of vasa previa.Around 85% of cases of vasaprevia have one or more identifiable risk factors including in-vitro fertilization, multiple gestations, bilobed, succenturiate or low-lying placentas, and velamentous cord insertion (...) have recommended scheduled cesarean section of all asymptomatic women presenting with vasaprevia between 34 and 36 weeks' gestation.Prenatal diagnosis of vasaprevia is pivotal to prevent intrapartum fetal death. Although there is insufficient evidence to support the universal mid-gestation ultrasound screening for vasaprevia, recent evidence indicates the need for standardized prenatal targeted screening protocols of pregnancies at high-risk of vasaprevia.
Vasaprevia screening strategies: a decision and cost-effectiveness analysis. To perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasaprevia in singleton pregnancies.A decision-analytic model was constructed comparing vasaprevia screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios that were carried out at the time of mid-trimester ultrasound: no screening, ultrasound (...) -indicated screening, screening only pregnancies conceived by in-vitro fertilization (IVF) and universal screening. Ultrasound-indicated screening was defined as performing transvaginal ultrasound at the time of the routine anatomy ultrasound scan in response to one of the following sonographic findings associated with an increased risk of vasaprevia: low-lying placenta, marginal or velamentous cord insertion or bilobed or succenturiate lobed placenta. The primary outcome was cost per quality-adjusted
Vasaprevia with an intact amniotic membrane. 28286051 2018 01 26 2018 01 26 1097-6868 216 6 2017 Jun American journal of obstetrics and gynecology Am. J. Obstet. Gynecol. Vasaprevia with an intact amniotic membrane. 616.e1-616.e2 S0002-9378(17)30414-3 10.1016/j.ajog.2017.03.003 Matsuzaki Shinya S Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: firstname.lastname@example.org. Endo Masayuki M Department of Obstetrics (...) and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan. Kimura Tadashi T Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan. eng Case Reports Journal Article 2017 03 09 United States Am J Obstet Gynecol 0370476 0002-9378 AIM IM Adult Amnion pathology Female Humans Pregnancy VasaPrevia diagnosis pathology 2017 02 04 2017 02 24 2017 03 02 2017 3 14 6 0 2018 1 27 6 0 2017 3 14 6 0 ppublish 28286051 S0002-9378(17)30414-3 10.1016/j.ajog
Prenatal diagnosis and management of vasaprevia in twin pregnancies: A case series and systematic review. Twin pregnancies are at higher risks of velamentous cord insertion and vasaprevia. In vitro fertilization is an additional risk factor of abnormal cord insertion and thus the incidence of vasaprevia is likely to increase over the next decades.We sought to evaluate the role of ultrasound imaging in optimizing the management of twins diagnosed with vasaprevia antenatally.We searched our (...) database for twin pregnancies diagnosed with vasaprevia and managed antenatally using measurements of cervical length and performed a systematic review of articles that correlated prenatal diagnosis of vasaprevia in twins and pregnancy outcome. PubMed and MEDLINE were searched for studies published from 1987 through October 20, 2016, using specific medical subject heading terms, key words, and their combination. The primary eligibility criteria were articles that correlated prenatal ultrasound
Prenatally Diagnosed VasaPrevia: A Single-Institution Series of 96 Cases. To describe outcomes for a large cohort of women with prenatally diagnosed vasaprevia, determine the percentage in patients without risk factors, and compare delivery timing and indications for singletons and twins.This was a retrospective case series of women with prenatally diagnosed vasaprevia delivered at a single tertiary center over 12 years. Potential participants were identified using hospital records (...) and perinatal databases. Patients were included if vasaprevia was confirmed at delivery and by pathologic examination. Maternal and newborn data were gathered from medical records.There were 77 singleton and 19 twin pregnancies with a prenatal diagnosis of vasaprevia. There was one neonatal death from congenital heart disease. Perinatal management of recommended elective hospitalizations with corticosteroid administration and elective early delivery resulted in average gestational age for delivery
VasaPrevia: Diagnosis and Management. Vasaprevia is a rare condition that is associated with a high rate of fetal or neonatal death when not diagnosed antenatally. The majority of available studies are either small, do not include antepartum data, limited to single institutions, or are biased by inclusion of patients from registries and online vasaprevia support groups.The purpose of this study was to investigate the diagnostic and management strategies for this potentially catastrophic (...) entity and to describe further maternal and placental risk factors that may aid in the establishment of a screening protocol for vasa previa.This was a retrospective multicenter descriptive study that included all pregnancies that were complicated by vasaprevia that delivered between January 1, 2000, and December 31, 2012. Nine maternal fetal medicine practices and the hospitals in which they practice participated in data collection of diagnosis, treatment, and maternal-neonatal outcomes.Sixty-eight
VasaPreviaVasaPrevia Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 VasaPreviaVasaPrevia Aka: VasaPrevia , Ruptured Vasa (...) trimester In Vitro fertilization (IVF) Bilobed or succenturiate lobe of placenta (e.g. ) VII. Symptoms and signs immediately after membrane rupture Vessel may be palpable on cervical exam VIII. Labs: Only in stable cases Wright's stain IX. Radiology with color flow doppler Differentiate from Consider in stable cases with suspected VasaPrevia Not indicated for general screening X. Management: Emergent See Heavy bleeding or non-reassuring Requires immediate delivery Do not delay delivery for labs
of delivery for vasa praevia are needed. 11 Auditable topics Appropriate delivery plan in place if an antenatal diagnosis of vasa praevia is made (100%). 12 Useful links and support groups Vasa praevia raising awareness [ ]. The International VasaPrevia Foundation [ ]. Royal College of Obstetricians and Gynaecologists. Low‐lying placenta after 20 weeks (placenta praevia). Information for you . London: RCOG; 2018 [ ]. UK National Screening Committee. The UK NSC recommendation on Vasa praevia screening (...) di Napoli Federico II, Naples, Italy; RCOG Women's Network; Dr R Salim, Emek Medical Center, Afula, Israel; Dr JT Thomas FRANZCOG, CMFM, Mater Mothers’ Hospital, Brisbane, Australia; Mr N Thomson, Society and College of Radiographers, London; Dr M Tikkanen, Women′s Clinic, Helsinki University Hospital Finland, Helsinki, Finland; UK National Screening Committee; Vasa Praevia Ireland Support and Awareness Group; and Vasa Praevia Raising Awareness for the UK and the International VasaPrevia
Abnormal Placentation: Placenta Previa, VasaPrevia, and Placenta Accreta. Placental disorders such as placenta previa, placenta accreta, and vasaprevia are all associated with vaginal bleeding in the second half of pregnancy. They are also important causes of serious fetal and maternal morbidity and even mortality. Moreover, the rates of previa and accreta are increasing, probably as a result of increasing rates of cesarean delivery, maternal age, and assisted reproductive technology
Systematic review of accuracy of ultrasound in the diagnosis of vasaprevia. Vasaprevia is an obstetric complication in which the fetal blood vessels lie outside the chorionic plate in close proximity to the internal cervical os. In women with vasaprevia, the risk of rupture of these vessels is increased, thus potentially causing fetal death or serious morbidity. Our objective was to assess the accuracy of ultrasound in the prenatal diagnosis of vasa previa.We searched MEDLINE, EMBASE (...) , the Cochrane Library and PubMed for studies on vasaprevia. Two reviewers independently selected studies on the accuracy of ultrasound in the diagnosis of vasaprevia. The studies were scored on methodological quality using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2). Data on sensitivity and specificity were subsequently extracted.The literature search revealed 583 articles, of which two prospective and six retrospective cohort studies were eligible for inclusion
Reporting of outcomes in studies on pregnant women with vasaprevia: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith" or "Joanne") for correspondence: Organisation web address: Timing
Fetoscopic laser ablation of vasaprevia for a fetus with a giant cervical lymphatic malformation. 25612246 2016 08 18 2016 11 25 1469-0705 46 4 2015 Oct Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Ultrasound Obstet Gynecol Fetoscopic laser ablation of vasaprevia in pregnancy complicated by giant fetal cervical lymphatic malformation. 507-8 10.1002/uog.14796 Hosseinzadeh P P Division of Maternal Fetal (...) College of Medicine, Houston, TX, USA. eng Case Reports Letter England Ultrasound Obstet Gynecol 9108340 0960-7692 IM Adult Cesarean Section methods Female Fetal Diseases diagnostic imaging pathology surgery Fetoscopy methods Humans Laser Coagulation methods Laser Therapy methods Lymphatic Abnormalities diagnostic imaging pathology surgery Magnetic Resonance Imaging methods Polyhydramnios diagnosis diagnostic imaging etiology Pregnancy Prenatal Diagnosis methods Ultrasonography VasaPrevia diagnostic
Indefinite Fetal Heart Rate Pattern in a Patient with VasaPrevia: A Situation Where Guideline Is Inapplicable Most fetal heart rate patterns can be interpreted accurately so that management decisions can be made correctly. How-ever, few fetal heart rate patterns are so ambiguous that the obstetricians cannot interpret them precisely. A 27-year-old woman at 38 weeks' gestation in her first pregnancy was admitted with heavy vaginal bleeding and decrease in fetal movements. Fetal status (...) was indeterminate according to an indefinite fetal heart rate tracing with regular decelerations. After emergent cesarean delivery, a ruptured vasaprevia, traversing the fetal membrane, unsupported by either the umbilical cord or placental tissue, was clearly identified. Treatment decision-making is challenging in such patient with indefinite fetal heart rate pattern because limited data exist to guide management. Well-designed studies are needed to clarify the uncertainty about the effect of indefinite fetal