Vasa previa: Prenatal diagnosis and management

Yaakov Melcer, Ron Maymon, Eric Jauniaux

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose of review Vasa previa 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. Recent findings Around 85% of cases of vasa previa have one or more identifiable risk factors including in-vitro fertilization, multiple gestations, bilobed, succenturiate or low-lying placentas, and velamentous cord insertion. The development of standardized prenatal targeted scanning protocols may improve perinatal outcomes. There is no clear consensus on the optimal surveillance strategy including the need for hospitalization, timing of corticosteroids administration and the value of transvaginal cervical length measurements. Outpatient management is possible if there is no evidence of cervical shortening on ultrasound and there are no symptoms of bleeding or uterine contractions. Recent national guidelines and expert reviews have recommended scheduled cesarean section of all asymptomatic women presenting with vasa previa between 34 and 36 weeks' gestation. Summary Prenatal diagnosis of vasa previa is pivotal to prevent intrapartum fetal death. Although there is insufficient evidence to support the universal mid-gestation ultrasound screening for vasa previa, recent evidence indicates the need for standardized prenatal targeted screening protocols of pregnancies at high-risk of vasa previa.

Original languageEnglish
Pages (from-to)385-391
Number of pages7
JournalCurrent Opinion in Obstetrics and Gynecology
Volume30
Issue number6
DOIs
StatePublished - 2018

Keywords

  • Cervical length
  • Management
  • Prenatal diagnosis
  • Ultrasound
  • Vasa previa

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