Vasa praevia with meandering foetal vessels despite placental and umbilical cord insertion on the same side of the uterine wall: a case report

A 38‐year‐old patient with gravida 2, para 1 was referred to our hospital for perinatal management. At 37 weeks gestation, we diagnosed vasa praevia with meandering foetal vessels. Emergent caesarean section was performed. Obstetricians should be familiar with vasa praevia with meandering foetal vessels despite its rare occurrence.

Antepartum haemorrhage

Antepartum haemorrhage (APH) remains a leading cause of maternal and perinatal morbidity and mortality across the world. As a key component of obstetric haemorrhage, it features high on the list of near-miss obstetric events; thus highlighting the continued importance of developing strategies aimed at reducing the negative impact on maternal and fetal outcome. The causes of APH include placenta praevia, placenta accreta, placenta abruption, vasa praevia, and local genital causes. Some cases of APH would be retrospectively classified as of unknown origin. Placenta praevia, placenta abruption, and vasa praevia have the greatest impact on maternal and fetal morbidity and mortality. The impact of APH on pregnancy outcome is more pronounced in low-resourced countries when compared to developed economies; therefore, a system-oriented approach based on sound evidence and multidisciplinary involvement with regularly rehearsed drills is required to drive a sustained improvement in the management of APH across the world. The rising incidence of placenta accreta, with the associated risk and complexity, presents an ongoing challenge, and the adoption of a composite care bundle that incorporates key components of multidisciplinary care is highly recommended.

Case report: a rapid review approach used by the UK National Screening Committee to inform recommendations on general population screening for vasa praevia

Background The UK National Screening Committee (UK NSC) reviews evidence about existing or potential population screening programmes using rapid review products called evidence summaries. We provide a case report as an example of how rapid reviews are developed within the UK NSC’s process, consider how the quality of rapid reviews should be assessed and ask whether the rapid review was an appropriate tool to inform the UK NSC’s decision-making process. Methods We present the rapid review approach taken by the commissioner and the reviewers to develop an evidence summary for vasa praevia (VP), which the UK NSC reappraised as part of its 3-yearly cycle for conditions where screening is currently not recommended. We apply the AMSTAR 2 quality appraisal checklist for systematic reviews, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and a published checklist of items to consider with a rapid review approach. As UK NSC evidence summaries do not include meta-analyses, any related AMSTAR 2 or PRISMA checklist items were considered inapplicable. Results The evidence summary was available within the required timelines and highlighted little change from the previous review in terms of key evidence gaps relating to the epidemiology of VP, the screening test and the management pathway. Therefore, the UK NSC concluded that there was insufficient evidence to support a change in its previous recommendation against screening. The evidence summary scored moderately against the applicable AMSTAR 2 and PRISMA checklist items. Against the published checklist of items to consider with a rapid review approach, the evidence summary performed well. Conclusions In this case report, the use of a rapid review as part of the UK NSC’s process enabled a pragmatic approach to assessing the overall volume, quality and direction of literature on key questions relating to the viability of a population screening programme for VP. Based on our assessments of this single evidence summary, systematic review quality appraisal tools may undervalue rapid reviews. The validity of the methods used in this case report, as well as the wider generalisability of our insights relating to rapid review practice, reporting and quality assessment, requires analysis of a larger sample of rapid reviews.