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1.
J Perinat Med ; 49(7): 915-922, 2021 Sep 27.
Article in English | MEDLINE | ID: mdl-33939903

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.


Subject(s)
Ultrasonography, Doppler, Color , Ultrasonography, Prenatal , Vasa Previa/diagnosis , Adult , Female , Humans , Infant, Newborn , Male , Postnatal Care , Pregnancy , Prenatal Care , Prognosis , Remission, Spontaneous , Retrospective Studies , Sensitivity and Specificity , Vasa Previa/pathology , Vasa Previa/therapy
3.
Obstet Gynecol ; 136(6): 1211-1216, 2020 12.
Article in English | MEDLINE | ID: mdl-33156190

ABSTRACT

The most common anomalies of implantation of the placenta and umbilical cord include placenta previa, placenta accreta spectrum, and vasa previa, and are associated with considerable perinatal and maternal morbidity and mortality. There is moderate quality evidence that prenatal diagnosis of these conditions improves perinatal outcomes and the performance of ultrasound imaging in diagnosing them is considered excellent. The epidemiology of placenta previa is well known, and it is standard clinical practice to assess placental location at the routine screening second-trimester detailed fetal anatomy ultrasound examination. In contrast, the prevalence of placenta accreta spectrum and vasa previa in the general population is more difficult to evaluate because detailed confirmatory histopathologic data are not available in most studies. The sensitivity and specificity of ultrasonography for the diagnosis of these anomalies is also difficult to assess. Recent epidemiologic studies show an increase in the incidence of placental and umbilical cord implantation anomalies, which may be the result of increased use of assisted reproductive technology and cesarean delivery. There is good evidence to support targeted standardized protocols for women at high risk and that screening and diagnosing placenta accreta spectrum and vasa previa should be integrated into obstetric ultrasound training programs.


Subject(s)
Placenta Accreta/diagnostic imaging , Placenta Previa/diagnostic imaging , Umbilical Cord/pathology , Vasa Previa/diagnostic imaging , Female , Humans , Placenta Accreta/epidemiology , Placenta Accreta/pathology , Placenta Previa/epidemiology , Placenta Previa/pathology , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Second , Prenatal Diagnosis , Ultrasonography, Prenatal , Vasa Previa/epidemiology , Vasa Previa/pathology
7.
J Reprod Med ; 61(11-12): 598-600, 2016.
Article in English | MEDLINE | ID: mdl-30226732

ABSTRACT

Background: Fetal hemorrhage is rare but can result in rapid fetal compromise. Abnormally located fetal vessels within the membranes increase the risk for their rupture and subsequent hemorrhage. The classic example of this is vasa previa. Case: We present a case of acute fetal hemorrhage resulting from a ruptured fetal vessel. During induction of labor, significant fetal heart rate deceleration occurred, coinciding with acute vaginal bleeding and amniotomy. A depressed, live female neonate was delivered by emergency cesarean section. Examination of the placenta revealed a velamentous cord insertion and a ruptured fetal vessel coursing through the chorioamniotic membranes. Neonatal resuscitation included red blood cell transfusion for hypotension and low hematocrit. The neonate made a full recovery. Conclusion: Acute fetal hemorrhage from the rupture of aberrant fetal vessels often coincides with rupture of membranes. Identifying ruptured fetal vessels abnormally coursing through the chorioamniotic membranes on examination of the placenta provides supporting evidence for suspected fetal hemorrhage.


Subject(s)
Placenta/pathology , Umbilical Cord/pathology , Uterine Hemorrhage/pathology , Adult , Cesarean Section , Female , Humans , Infant, Newborn , Pregnancy , Pregnancy Complications, Hematologic/pathology , Prenatal Care , Vasa Previa/pathology
8.
J Obstet Gynaecol Can ; 37(8): 679, 2015 Aug.
Article in English, French | MEDLINE | ID: mdl-26474220
9.
Rom J Morphol Embryol ; 56(1): 301-8, 2015.
Article in English | MEDLINE | ID: mdl-25826521

ABSTRACT

Among the abnormal cord insertion pathology, velamentous cord insertion associated with rupture of vasa praevia is the most severe condition related to the outcome of the newborn. In velamentous cord insertion, the fetal vessels run freely through the fetal membranes without protection from Wharton's jelly, umbilical vessels diverging as they traverse the membranes. When the membranes are ruptured, complete tearing of fetal vessels through the torn membranes or partial rupture near the site of membrane rupture may occur. Velamentous insertion occurs in approximately 1% of singleton gestations, but is observed in as many as 15% of monochorionic twin gestations. The risk of perinatal death was doubled in pregnancies with velamentous cord insertion relative to normal cord insertion. This condition can be diagnosed by ultrasonography with a sensitivity of 67% and specificity of 100% in the second trimester. We report a case of a newborn who came from a velamentous cord insertion condition associated with rupture of vasa praevia after the spontaneously membranes rupture. After a difficult resuscitation and stabilization, the newborn survived with a good outcome after the follow-up.


Subject(s)
Umbilical Cord/pathology , Vasa Previa/pathology , Acidosis/diagnosis , Adult , Asphyxia/etiology , Female , Humans , Infant, Newborn , Male , Placenta/pathology , Pregnancy , Pregnancy Outcome , Prognosis , Resuscitation , Sensitivity and Specificity , Shock/etiology , Treatment Outcome , Ultrasonography , Ultrasonography, Prenatal
11.
J Matern Fetal Neonatal Med ; 28(15): 1806-8, 2015.
Article in English | MEDLINE | ID: mdl-25338011

ABSTRACT

Vasa previa is a rare condition in which unsupported by the placenta, umbilical cord blood vessels runs within the placental membranes between internal os of the cervix and presenting part of the fetus. We report an antenatal diagnostic procedure and management of a patient with low-lying placenta and velamentous cord insertion near to the internal os with two large fetal blood vessels coursing between the internal cervical os and fetal presenting part. An elective cesarean section was performed at 36 weeks gestation.


Subject(s)
Vasa Previa/diagnostic imaging , Adult , Cesarean Section , Female , Humans , Placenta/diagnostic imaging , Placenta/pathology , Placenta/surgery , Pregnancy , Ultrasonography, Prenatal , Umbilical Cord/diagnostic imaging , Umbilical Cord/pathology , Vasa Previa/pathology , Vasa Previa/surgery
12.
J Gynecol Obstet Biol Reprod (Paris) ; 42(6): 591-5, 2013 Oct.
Article in French | MEDLINE | ID: mdl-23287072

ABSTRACT

Vasa previa is a rare complication of pregnancy (1/2000 to 1/6000) with a high fetal mortality rate (75 to 100%). We will discuss two case reports of vasa previa: the first was diagnosed before labor, while the second was during delivery. In the first case, the diagnosis of vasa previa was confirmed by a transvaginal ultrasound and color doppler, while the second case involved late diagnosis during delivery and after gross examination of the placenta. Risk factors for vasa previa are: low-lying placenta, bilobed or succenturiate lobed placenta, velamentous and in vitro fertilization (IVF). Antenatal diagnosis of vasa previa is crucial because it allows for prophylactic caesarean section and prevents severe Benckiser's hemorrhage responsible for a very high neonatal mortality.


Subject(s)
Vasa Previa/diagnosis , Adult , Cesarean Section , Delivery, Obstetric , Female , Fertilization in Vitro/adverse effects , Hemorrhage/prevention & control , Humans , Infant, Newborn , Placenta/pathology , Pregnancy , Prenatal Diagnosis , Prognosis , Risk Factors , Ultrasonography, Prenatal , Vasa Previa/diagnostic imaging , Vasa Previa/pathology
13.
Ultraschall Med ; 34(4): 368-76, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23023454

ABSTRACT

PURPOSE: Undiagnosed vasa praevia carries an imminent risk of fetal death and increases with IVF. When diagnosed, the question arises as to whether the conventional prenatal management of routine steroid administration for fetal lung maturation and elective caesarean section in week 35 is generally justified in face of the risks involved. We present a retrospective study of a risk-adapted modification of the conventional management of vasa praevia. MATERIAL AND METHODS: We analysed 11 years of records involving 18 cases of antenatally diagnosed vasa praevia at our perinatal centre. Each case was managed by a risk-adapted modification of the conventional treatment where both, the steroid administration and the timing of delivery, were dependent on the patient history and clinical signs for preterm birth. RESULTS: There were no lethal fetal, neonatal, or maternal complications. The earliest caesarean section took place at 34 weeks 1 day, the latest at 37 weeks 1 day, and in more than half of the cases at ≥ 36 weeks. CONCLUSION: Steroid application is generally recommended for pregnancies before 34 weeks carrying a risk for preterm birth. Thus, retrospectively, none of our cases required steroid administration. This supports our protocol of not obligatorily administering steroids. Delaying the caesarean section up to two weeks beyond the conventionally recommended date of 35 weeks in 78% of our cases resulted in no complications. This justifies the suitability of determining the timing of delivery based on our individual patient assessment. In conclusion, the following recommendations for a risk-adapted management of vasa praevia can be made: 1. weekly evaluation of risk factors for preterm delivery; 2. steroid administration only at risk for preterm birth; 3. admission to hospital with full obstetric and neonatal care facilities between 32 and 34 weeks; 4. elective caesarean section between 35 and 37 weeks, risk-adapted.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Cesarean Section , Ultrasonography, Prenatal , Vasa Previa/diagnostic imaging , Vasa Previa/therapy , Diagnosis, Differential , Female , Fetal Death , Gestational Age , Humans , Infant, Newborn , Placenta/blood supply , Placenta/diagnostic imaging , Placenta/pathology , Pregnancy , Pregnancy Outcome , Retrospective Studies , Rupture, Spontaneous , Ultrasonography, Doppler, Color , Vasa Previa/pathology
15.
Prenat Diagn ; 30(12-13): 1121-5, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20872421

ABSTRACT

OBJECTIVES: To clarify the ultrasonographic findings indicative of prenatal vasa previa. METHODS: The variables associated with placental and umbilical cord abnormalities were retrospectively analysed in cases with and without vasa previa. RESULTS: Consecutive subjects were divided into those with vasa previa (10) and controls (4682). Abnormal placental forms and placenta previa/low-lying placenta were associated with vasa previa [odds ratio (OR) 21.9 and 28.0]. While the frequency of velamentous cord insertion was 1.6% in the controls, it was 90% in the cases with vasa previa (OR 552). In addition, low cord insertions in the uterus were observed in 90% of the patients with vasa previa and only in 0.4% of the controls (OR 2470). Descending cords were also frequently observed in patients with vasa previa (OR 89.8). Finally, a multivariable regression analysis demonstrated an OR of 65.1 (95% confidence interval (CI) 5.8-733) for velamentous cord insertion and an OR of 344.7 (95% CI 31-3838) for low cord insertion with regard to the risk of vasa previa. CONCLUSION: Our results suggest that confirmation of the placental cord insertion, including not only velamentous cord insertion but also the cords located on the lower uterine segment, is the best way to detect vasa previa.


Subject(s)
Ultrasonography, Prenatal , Vasa Previa/diagnostic imaging , Adult , Case-Control Studies , Female , Humans , Multivariate Analysis , Odds Ratio , Placenta/diagnostic imaging , Placenta/pathology , Pregnancy , Prognosis , Retrospective Studies , Ultrasonography, Prenatal/standards , Ultrasonography, Prenatal/statistics & numerical data , Umbilical Cord/diagnostic imaging , Umbilical Cord/physiology , Vasa Previa/pathology , Vasa Previa/physiopathology
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