Vasa previa: when antenatal diagnosis can change fetal prognosis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Miriam Sutera ◽  
Anna Garofalo ◽  
Eleonora Pilloni ◽  
Silvia Parisi ◽  
Maria Grazia Alemanno ◽  
...  
Keyword(s):  
Risk Factor ◽  
Predictive Value ◽  
Placenta Previa ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Spontaneous Resolution ◽  
Fetal Mortality ◽  
Second Trimester ◽  
Vasa Previa ◽  
Fetal Vessels

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.

Estimation of probability of malignancy using a logistic model combining color Doppler ultrasonography, serum CA125 level in women with a pelvic mass

2006 ◽  
Vol 16 (Suppl 1) ◽  
pp. 92-98 ◽  
Author(s):  
A. S. Mousavi ◽  
S. Borna ◽  
S. Moeinoddini
Keyword(s):  
Predictive Value ◽  
Scoring System ◽  
Malignant Tumors ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Resistance Index ◽  
Doppler Imaging ◽  
Ca125 Level ◽  
Serum Ca125 ◽  
Serum Ca125 Level

The goal of this study was to develop a scoring system using combination of Doppler characterization of pelvic/ovarian lesions and serum CA125 level. Our purpose was to maximize the preoperative discrimination between benign and malignant entities. In a prospective study, a total of 101 patients were evaluated preoperatively using a standard transvaginal ultrasound and color Doppler imaging with pulse spectral analysis and serum CA125 level within a week prior to surgery. The variables that were analyzed by the multivariate logistic regression method are as follows: tumor structure, ascites, presence of septum, the peak systolic velocity (PSV), the resistance index (RI), and serum CA125 level. Of the 101 patients qualified for the study, 48 patients were diagnosed with benign (47.5%) and 53 (52.5%) with malignant tumors. Each criterion used alone provides statistically significant discrimination between benign and malignant tumors. Four criteria could be combined in a malignancy score which is calculated using the product of the serum CA125 level (1 if CA125 ≥40 U/mL and 0 if CA125 <40 U/mL), the result of sonography for presence of septum in tumor (1 if there was septum ≥3 mm, 0 if there was no septum or <3 mm), result of Doppler flow imaging as RI (1 if RI ≤0.5 and 0 if RI >0.5) and the PSV (1 if PSV ≥40 cm/s and 0 if PSV <40 cm/s). This scoring system devised was statistically more effective discriminator between cancer and benign lesions than formal methods. Using malignancy score cutoff level of two, the sensitivity was 98% (CI 88.62–99.9.), the specificity was 85% (CI 71.62–93.45), the positive predictive value was 87.5%, and the negative predictive value was 97.6%. Area under curve of receiver operative characteristic curves was 0.987 (CI 0.971–1.004). These values were statistically more significant than those obtained from the independent use of RI, PSV, or serum CA125 level at their optimum decision values (P < 0.05). There is a need for a prospective evaluation of this score using a larger sample of patients.

scholarly journals In Vitro Fertilization and Vasa Previa: A Report of Two Cases

2019 ◽  
Vol 41 (05) ◽  
pp. 348-351
Author(s):  
Ana Lúcia Isotton ◽  
Cristiano Caetano Salazar ◽  
Cleisson Fábio Andrioli Peralta ◽  
Juliana Moysés Leite Abdalla ◽  
Janete Vettorazzi
Keyword(s):  
Risk Factor ◽  
Prenatal Diagnosis ◽  
In Vitro Fertilization ◽  
Cesarean Section ◽  
Apgar Score ◽  
Transvaginal Ultrasound ◽  
Caucasian Woman ◽  
Vitro Fertilization ◽  
Vasa Previa

AbstractVasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.

Association of Vasa Previa at Delivery With a History of Second-Trimester Placenta Previa

2004 ◽  
Vol 59 (4) ◽  
pp. 245-247 ◽  
Author(s):  
Karrie Francois ◽  
Staci Mayer ◽  
Cathleen Harris ◽  
Jordan H. Perlow
Keyword(s):  
Placenta Previa ◽  
Second Trimester ◽  
Vasa Previa ◽  
History Of

scholarly journals Challenges in Diagnosis of Pseudo Vasa Previa

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Etsuko Kajimoto ◽  
Shinya Matsuzaki ◽  
Satoko Matsuzaki ◽  
Yusuke Tanaka ◽  
Yukiko Kinugasa-Taniguchi ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Doppler Ultrasonography ◽  
Placenta Previa ◽  
Color Doppler ◽  
Color Doppler Ultrasonography ◽  
Accurate Identification ◽  
Appropriate Treatment ◽  
Vasa Previa ◽  
Obstetrical Complication

Vasa previa is a rare but clinically important obstetrical complication that can be associated with a low-lying placenta or placenta previa. We aim to convey the challenges in diagnosing this condition by presenting 2 cases of pseudo vasa previa diagnosed antenatally as vasa previa using standard and color Doppler ultrasonography. Both patients were falsely diagnosed; only a low-lying placenta was revealed after delivery. These reports emphasize that accurate identification of vasa previa on cervical imaging is important for determining an appropriate treatment strategy.

scholarly journals Vasa previa: a case report

2020 ◽  
Vol 9 (10) ◽  
pp. 4301
Author(s):  
Ipsita Mohapatra ◽  
Subha R. Samantaray ◽  
V. Naga Sindhuja
Keyword(s):  
Neonatal Outcome ◽  
Placenta Previa ◽  
Placental Tissue ◽  
Multiple Pregnancies ◽  
Lower Segment ◽  
Vitro Fertilization ◽  
Vasa Previa ◽  
History Of ◽  
Fetal Vessels

Vasa previa is defined as a condition where fetal vessels traverse the membranes in the lower segment below the presenting part unsupported by placental tissue or umbilical cord. Rupture of the membranes leads to fetal exsanguinations and even neonatal death. The etiology is uncertain, but risk factors include bilobed or succenturiate lobed placenta, velamentous insertion of cord, placenta previa, pregnancies resulting from In vitro fertilization (IVF) and multiple pregnancies. We report here a case of 24 year old woman, G3A2 at 34 weeks of gestation and history of 2 previous spontaneous abortions with vasa previa which was successfully managed. Prenatal sonographic diagnosis has the potential to improve or prevent the poor obstetric and neonatal outcome associated with it.

scholarly journals Incarcerated Gravid Uterus: Spontaneous Resolution Is Not Rare

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1544
Author(s):  
Daisuke Tachibana ◽  
Takuya Misugi ◽  
Kohei Kitada ◽  
Yasushi Kurihara ◽  
Mie Tahara ◽  
...  
Keyword(s):  
Placenta Previa ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Spontaneous Resolution ◽  
Adverse Outcomes ◽  
University Hospital ◽  
Gravid Uterus ◽  
Second Trimester ◽  
Obstetrical Complication ◽  
Near Term

Aim: Incarcerated gravid uterus is a rare obstetrical complication that leads to adverse outcomes, especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery. However, there is no consensus regarding the optimal management of this complication because of its rarity. In this study, we aimed to elucidate the incidence of incarcerated gravid uterus, as well as its natural courses and perinatal outcomes. Methods: We retrospectively reviewed medical records of patients who had incarcerated gravid uterus and managed at Osaka City University Hospital between April 2011 and March 2021. Incarcerated gravid uterus was defined as a retroverted or retroflexed uterus after 16 weeks of gestation. Results: There were 14 incarcerated cases among 6958 pregnant women, and 13 of them had some kind of gynecological complication and/or history. Spontaneous resolution of incarcerated gravid uterus after 16 gestational weeks was observed in six cases before the late second trimester and five cases at the late second trimester to early third trimester. Three cases remained incarcerated at term or near-term. One case with adenomyosis had severe abdominal pain, although it was difficult to ascertain whether the cause of pain was triggered by adenomyosis and/or incarceration. One case was misdiagnosed as placenta previa, and the uterine cervix was subsequently injured during cesarean delivery, resulting in massive hemorrhaging. Conclusions: Approximately 1 in 2300 pregnancies continued to be in an incarcerated condition at term or near-term, and 78.5% of cases showed a spontaneous resolution after 16 weeks of gestation. Expectant management with careful attention to the incarcerated gravid uterus may be one option in situations where there are no severe symptoms related to the incarceration itself.

Effectiveness of ultrasound screening for placenta accreta spectrum using standard ultrasound criteria in a secondary care setting

2022 ◽  
Author(s):  
Miquel Juan-Clar ◽  
Marta Torrent ◽  
Pere Santandreu ◽  
Eva Arejola ◽  
Javier Ibarra ◽  
...  
Keyword(s):  
At Risk ◽  
Predictive Value ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Transvaginal Ultrasound ◽  
Secondary Level ◽  
Histopathological Analysis ◽  
Ultrasound Screening ◽  
Placenta Accreta Spectrum ◽  
Level Hospital

Objectives: Ultrasound detection of placenta accreta spectrum (PAS) among women at risk is a key goal to reduce obstetric morbidity, but there is scarce information of its performance in real clinical settings. We report the effectiveness of a standardized ultrasound protocol to detect PAS in women with placenta previa in a secondary-level hospital. Methods: A retrospective analysis, including a cohort of 126 women with persistent placenta previa among 27,975 pregnancies between 2008 and 2020. All 126 women underwent standardized transabdominal and transvaginal ultrasound assessing 5 criteria: 1) loss of hypoechoic retroplacental zone and/or myometrial thinning <1 mm; 2) lacunar images with flow >15 cm/sec; 3) thick and bulging placenta; 4) thinning or interruption of the uterine-bladder serous interface; and 5) placental or uterovesical hypervascularity. The presence of at least one criterion was considered a high-risk for PAS. Diagnosis of PAS was confirmed during caesarean section and by histopathological analysis. Results: Among 126 women with placenta previa, 11 (8.7%) cases of PAS were diagnosed, of which 10 were detected prenatally by ultrasound. This resulted in a sensitivity of 90,9%, a specificity of 98,3%, a positive predictive value (PPV) of 83,3%, and negative predictive value (NPV) of 99,1%. Histopathological assessment showed six placenta increta (54.5%), four percreta (36.4%) and one accreta (9.1%). All 10 cases of invasive placenta presented more than three ultrasound criteria. Conclusions: Standardized ultrasound screening protocol in women at risk due to placenta previa in the third trimester was highly effective in detecting PAS in a secondary-level hospital setting.

scholarly journals Clinical case of delivery of a pregnant woman with Vasa previa on the background of Placenta previa/accreta

2021 ◽  
Vol 4 ◽  
pp. 23-29
Author(s):  
О.V. Golyanovskiy ◽  
O.A. Dyadyk ◽  
V.I. Oshovskyy ◽  
N.E. Geint ◽  
V.V. Mekhedko ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Umbilical Cord ◽  
Clinical Case ◽  
Placenta Previa ◽  
Multiple Pregnancy ◽  
Diagnostic Methods ◽  
Doppler Imaging ◽  
Fetal Mortality ◽  
Standard Clinical Practice ◽  
Vasa Previa

Vasa previa is characterized by the presentation of blood vessels of the umbilical cord, which pass through the amniotic sac over the inner eye of the cervix or in its immediate vicinity (up to 5 cm) and are associated with umbilical cord blood flow and are in front of the anterior part of the fetus.Risk factors for Vasa Previa are placental pathology, in particular placenta previa and low placental location; membranous attachment of the umbilical cord, IVF, the presence of an additional share of the placenta or dichotomous placenta, as well as multiple pregnancy. Without prior diagnosis of Vasa previa, fetal mortality reaches 44%, while in antenatal detection the survival rate is up to 97%.Current standard clinical practice during pregnancy with obstetric risk factors for Vasa previa includes assessment of the condition of the lower segment of the uterus and cervix using TVUS and enhanced / color Doppler imaging. The use of additional modern diagnostic methods is a very important step in the aspect of differential diagnosis, especially when additional structures are visualized in the immediate vicinity of the cervix.The article describes a clinical case of Vasa previa on the background of Placenta previa / accreta in women with a burdened somatic and obstetric history and with 4 previous surgeries on the pelvic organs (laparotomy). The management of a clinical case with timely diagnosis and delivery with the help of modern medical and technical support of cesarean section (tranexamic acid, carbetocin, argon plasma tissue coagulation) is presented. Pathology and histology data confirming the diagnosis are attached as well.Thanks to the use of modern methods of diagnosis and delivery, it was possible to prevent severe complications, primarily hemorrhagic, both from the fetus and from the pregnant woman with a rather rare obstetric pathology in the form of Vasa previa with umbilical cord membranous attachment, Placenta previa / accreta partialis.

Body Mass Index, Follicle-Stimulating Hormone and their Predictive Value in vitro Fertilization

2018 ◽  
Vol 69 (7) ◽  
pp. 1842-1845
Author(s):  
Lavinia Stelea ◽  
Izabella Petre ◽  
Marius Craina ◽  
Brigitha Vlaicu ◽  
Alina Sisu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Risk Factor ◽  
In Vitro Fertilization ◽  
Body Mass ◽  
Predictive Value ◽  
Follicle Stimulating Hormone ◽  
Vitro Fertilization ◽  
Weight Problems ◽  
Fertility Disorder

The aim of this study was to determine if body mass can be considered a risk factor for infertility, and if we can find any correlations between the age values and the FSH and estradiol values, and between the BMI values and the FSH and estradiol values. Our whole sample contains 100 patients splinted in two groups (pregnant patients N1=57 subjects, 57%, and not � pregnant patients N1=43 subjects,43%). In the first part we conducted our analysis on the whole group and after that we focused the analysis on the two groups and we made some comparisons between the groups. We obtained a medium, extremely significant correlation in all scenarios between the age and the FSH values. This is the best association from all the cases which we tested. In all twelve cases we have a positive correlation (r ] 0). As well, we obtained that a BMI value higher than 25can be considered a risk factor for obtaining a pregnancy (p[0.05, RR ] 1, OR]1) . Our study shows that women who have weight problems have much less chances of conceiving a baby, even if they ovulate normally. The risk of infertility increases proportionally to the extra pounds. Irregular ovulation in women is the most common fertility disorder due to obesity disease.

Sign in / Sign up

Export Citation Format

Share Document