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Am J Obstet Gynecol. 2019 Jun 12. pii: S0002-9378(19)30770-7. doi: 10.1016/j.ajog.2019.06.006. [Epub ahead of print]

Vasa Previa: A multicenter retrospective cohort study.

Author information

1
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
2
Department of Women's Health, Dell Medical School, University of Texas at Austin, Austin, TX; Austin Maternal-Fetal Medicine, Austin, Texas.
3
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA.
4
Department of Obstetrics & Gynecology, the University of Texas Medical Branch, Galveston, TX.
5
Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN.
6
Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham, AL.
7
Austin Maternal-Fetal Medicine, Austin, Texas.
8
Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX. Electronic address: alirezashamshirsaz@yahoo.com.

Abstract

OBJECTIVE:

To describe the characteristics and outcomes of patients with antenatal diagnosis of vasa previa and evaluate the predictive factors of resolution in a contemporary large multicenter dataset STUDY DESIGN: This was a retrospective multicenter cohort study of all antenatally diagnosed cases of vasa previa, , identified via ultrasound and electronic medical record, between January 2011 and July 2018 in 5 U.S. centers. Records were abstracted to obtain variables at diagnosis, throughout pregnancy, and outcomes, including maternal and neonatal variables. Data were reported as median [range] or n (%). Descriptive statistics, receiver operating characteristics and logistic regression analysis were used as appropriate.

RESULTS:

One-hundred-thirty-six cases of vasa previa were identified in 5 centers during the study period, 19 (14%) of which resolved spontaneously at median estimated gestational age of 27 weeks [19, 34]. All subjects with unresolved vasa previa underwent cesarean delivery at a median estimated gestational age of 34 weeks [27, 39] with the median estimated blood loss of 800 mL [250, 2000]. Rates for vaginal bleeding, preterm labor, premature rupture of membrane, and need for blood product transfusion were not different between the resolved and unresolved group (p=NS). The odds ratio for resolution in those with the estimated gestational age of less than 24 weeks at the time of diagnosis was 7.9 (95% CI: 2.1 - 29.4) after adjustment for confounding variables.

CONCLUSION:

Our data suggest that outcomes in antenatally diagnosed cases of vasa previa are excellent. Furthermore, our data reports higher chance of resolution when the condition is diagnosed before 24 weeks of gestation.

KEYWORDS:

Vasa previa; contemporary multicenter study; estimated gestational age at diagnosis; fetal mortality; maternal morbidity; resolution

PMID:
31201807
DOI:
10.1016/j.ajog.2019.06.006

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