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Oyelese Y. A 2-cm Distance Should Not Be Used to Define Vasa Previa. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:811-814. [PMID: 38293820 DOI: 10.1002/jum.16420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Yinka Oyelese
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Boston, Massachusetts, USA
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Oyelese Y, Javinani A, Shamshirsaz AA. Vasa Previa. Obstet Gynecol 2023; 142:503-518. [PMID: 37590981 PMCID: PMC10424826 DOI: 10.1097/aog.0000000000005287] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/10/2023] [Accepted: 05/05/2023] [Indexed: 08/19/2023]
Abstract
Vasa previa refers to unprotected fetal vessels running through the membranes over the cervix. Until recently, this condition was associated with an exceedingly high perinatal mortality rate attributable to fetal exsanguination when the membranes ruptured. However, ultrasonography has made it possible to diagnose the condition prenatally, allowing cesarean delivery before labor or rupture of the membranes. Several recent studies have indicated excellent outcomes with prenatally diagnosed vasa previa. However, outcomes continue to be dismal when vasa previa is undiagnosed before labor. Risk factors for vasa previa include second-trimester placenta previa and low-lying placentas, velamentous cord insertion, placentas with accessory lobes, in vitro fertilization, and multifetal gestations. Recognition of individuals who are at risk and screening them will greatly decrease the mortality rate from this condition. Because of the relative rarity of vasa previa, there are no randomized controlled trials to guide management. Therefore, recommendations on the diagnosis and management of vasa previa are based largely on cohort studies and expert opinion. This Clinical Expert Series review addresses the epidemiology, pathophysiology, natural history, diagnosis and management of vasa previa, as well as innovative treatments for the condition.
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Affiliation(s)
- Yinka Oyelese
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center/Harvard Medical School and Maternal Fetal Care Center at Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
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Furuya N, Sasaki T, Homma C, Hasegawa J, Suzuki N. Ultrasound screening and management of vasa previa in Japan. J Obstet Gynaecol Res 2020; 46:1084-1089. [PMID: 32281219 DOI: 10.1111/jog.14254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to clarify ultrasound screening and management for vasa previa (VP) in perinatal centers and primary facilities in Japan. METHODS A questionnaire survey about antepartum ultrasound screening and management for VP was delivered in 2018. Questions were sent by email or post to perinatal centers and randomly selected primary hospitals or clinics throughout Japan. RESULTS Seventy-seven perinatal centers and 300 primary facilities answered. VP was screened in 85.7% of perinatal centers and 81.3% of primary facilities. The reported incidence of VP was 0.05% (86/158 323) and 0.05% (28/54 791) in perinatal centers and primary facilities, respectively. When patients were diagnosed with VP, 88.7% of primary facilities referred the patient to a tertiary hospital. Routine hospitalization (100%) and steroid administration (46%) were frequently performed in perinatal centers. The median gestational age at planned cesarean section was significantly earlier in perinatal centers (34 weeks) than in primary facilities (37 weeks). Of the 31 reported cases of VP, 30 were reported as intact survival, but 1 case required an emergency cesarean section at 38 weeks of gestation without an antenatal diagnosis, resulting in neonatal death. CONCLUSION More than 80% of obstetric facilities both perinatal centers and clinics in Japan perform ultrasound screening with for VP with similar detection rate. However, to further improve perinatal outcomes related to VP, pathophysiology and diagnosis of VP should be more widely recognized by obstetric caregivers throughout Japan.
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Affiliation(s)
- Natsumi Furuya
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takamichi Sasaki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Chika Homma
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Junichi Hasegawa
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Nao Suzuki
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kanagawa, Japan
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Hasegawa J. Ultrasound screening of umbilical cord abnormalities and delivery management. Placenta 2018; 62:66-78. [DOI: 10.1016/j.placenta.2017.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/26/2022]
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Abstract
OBJECTIVES To describe the etiology of vasa previa and the risk factors and associated condition, to identify the various clinical presentations of vasa previa, to describe the ultrasound tools used in its diagnosis, and to describe the management of vasa previa. OUTCOMES Reduction of perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short-term and long-term maternal morbidity and mortality. EVIDENCE Published literature on randomized trials, prospective cohort studies, and selected retrospective cohort studies was retrieved through searches of PubMed or Medline, CINAHL, and the Cochrane Library, using appropriate controlled vocabulary (e.g., selected epidemiological studies comparing delivery by Caesarean section with vaginal delivery; studies comparing outcomes when vasa previa is diagnosed antenatally vs. intrapartum) and key words (e.g., vasa previa). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated into the guideline to October 1, 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and from national and international medical specialty societies. VALUES The evidence collected was reviewed by the Diagnostic Imaging Committee and the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS The benefit expected from this guideline is facilitation of optimal and uniform care for pregnancies complicated by vasa previa. SPONSORS The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENT A comparison of women who were diagnosed antenatally and those who were not shows respective neonatal survival rates of 97% and 44%, and neonatal blood transfusion rates of 3.4% and 58.5%, respectively. Vasa previa can be diagnosed antenatally, using combined abdominal and transvaginal ultrasound and colour flow mapping; however, many cases are not diagnosed, and not making such a diagnosis is still acceptable. Even under the best circumstances the false positive rate is extremely low. (II-2) RECOMMENDATIONS.
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Gagnon R. N° 231- Directive Clinique Sur La Prise en Charge Du Vasa Praevia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e456-e463. [PMID: 28935069 DOI: 10.1016/j.jogc.2017.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Westerway SC, Hyett J, Henning Pedersen L. Measuring leading placental edge to internal cervical os: Transabdominal versus transvaginal approach. Australas J Ultrasound Med 2017; 20:163-167. [PMID: 34760490 DOI: 10.1002/ajum.12065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We aimed to compare the value of transabdominal (TA) and transvaginal (TV) approaches for assessing the risk of a low-lying placenta. This involved a comparison of TA and TV measurements between the leading placental edge and the internal cervical os. We also assessed the intra-/interobserver variation for these measurements and the efficacy of TA measures in screening for a low placenta. METHODOLOGY Transabdominal and TV measurements of the leading placental edge to the internal cervical os were performed on 369 consecutive pregnancies of 16-41 weeks' gestation. The difference (TA-TV) from the mean was calculated and plotted against gestational age. Bland-Altman plots and paired t-tests were used to look at the differences in TA/TV measurement. Screening performance of a transabdominal approach was compared to a transvaginal 'gold standard'. Nonparametric methods were used to calculate the area under the receiver operator characteristics (ROC) curve. Intra-/interobserver variations were also calculated. RESULTS Of the pregnancies, 278 had a leading placental edge that was visible with the TV approach. Differences (TA-TV) ranged from -50 mm to +57 mm. Bland-Altman plot shows that TA measurements overestimated the distance compared with the TV measurements; the average difference in measurement was 12.0 mm (95% confidence interval 9.9-14.1). The sensitivity, specificity and negative predictive values of a TA approach were 18.2%, 97.5% and 87.2%, respectively. The receiver operator characteristics area between gestational weeks 16-23 was 0.81 (95% CI: 0.76-0.86). CONCLUSION The TA approach has a low sensitivity for detecting a low-lying placenta as choosing a TA cut-off with sensitivity >90% will decrease the specificity to 50%.
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Affiliation(s)
- Susan Campbell Westerway
- Faculty of Dentistry and Health Sciences Charles Sturt University Wagga Wagga New South Wales Australia
| | - Jon Hyett
- RPA Women and Babies Royal Prince Alfred Hospital University of Sydney Camperdown New South Wales Australia
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynaecology Aarhus University Hospital Aarhus Denmark.,Institute of Clinical Medicine Aarhus University Aarhus Denmark
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Can we perform a prenatal diagnosis of vasa previa to improve its obstetrical and neonatal outcomes? J Gynecol Obstet Hum Reprod 2017. [DOI: 10.1016/j.jogoh.2017.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Three dimensional transvaginal ultrasonography: Can it improve management in cases of laterally located minor placenta previa? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2015. [DOI: 10.1016/j.mefs.2014.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kapoor S, Thomas JT, Petersen SG, Gardener GJ. Is the third trimester repeat ultrasound scan for placental localisation needed if the placenta is low lying but clear of the os at the mid-trimester morphology scan? Aust N Z J Obstet Gynaecol 2014; 54:428-32. [DOI: 10.1111/ajo.12244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 07/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | - Joseph T. Thomas
- Department of Maternal Fetal Medicine; Mater Health Services; South Brisbane Australia
| | - Scott G. Petersen
- Department of Maternal Fetal Medicine; Mater Health Services; South Brisbane Australia
| | - Glenn J. Gardener
- Department of Maternal Fetal Medicine; Mater Health Services; South Brisbane Australia
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Velamentous cord insertion in a singleton pregnancy: an obscure cause of emergency cesarean-a case report. Case Rep Obstet Gynecol 2012; 2012:308206. [PMID: 23243528 PMCID: PMC3517836 DOI: 10.1155/2012/308206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/15/2012] [Indexed: 11/17/2022] Open
Abstract
Approximately 2% of low-risk pregnant women still require an emergency Cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. Velamentous cord insertion is an abnormal cord insertion in which the umbilical vessels diverge as they traverse between the amnion and chorion before reaching the placenta. With a reported incidence of 1% in singleton pregnancies, it has been associated with several obstetric complications. This condition has been diagnosed by ultrasonography with a sensitivity of 67% and specificity of 100% in the second trimester. The present case highlights the importance of the systematic assessment of the placental cord insertion site at routine obstetric ultrasound and the potential of identifying pregnancies with velamentous insertion and, therefore, those at risk for obstetric complications.
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Robinson AJ, Muller PR, Allan R, Ross R, Baghurst PA, Keirse MJ. Precise mid-trimester placenta localisation: Does it predict adverse outcomes? Aust N Z J Obstet Gynaecol 2012; 52:156-60. [DOI: 10.1111/j.1479-828x.2012.01416.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/16/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Alice J. Robinson
- Department of Obstetrics and Gynaecology; Monash Medical Centre; Melbourne; Victoria
| | | | - Richard Allan
- Division of Medical Imaging; Flinders Medical Centre
| | - Richard Ross
- Department of Obstetrics and Gynaecology; Monash Medical Centre; Melbourne; Victoria
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Oppenheimer LW, Farine D. A new classification of placenta previa: measuring progress in obstetrics. Am J Obstet Gynecol 2009; 201:227-9. [PMID: 19733273 DOI: 10.1016/j.ajog.2009.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 06/01/2009] [Indexed: 11/19/2022]
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Gagnon R, Morin L, Bly S, Butt K, Cargill YM, Denis N, Gagnon R, Hietala-Coyle MA, Lim KI, Ouellet A, Racicot MH, Salem S, Gagnon R, Hudon L, Basso M, Bos H, Delisle MF, Farine D, Grabowska K, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A. Directive clinique sur la prise en charge du vasa praevia. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009. [DOI: 10.1016/s1701-2163(16)34283-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gagnon R, Morin L, Bly S, Butt K, Cargill YM, Denis N, Gagnon R, Anne Hietala-Coyle M, Lim KI, Ouellet A, Racicot MH, Salem S, Gagnon R, Hudon L, Basso M, Bos H, Delisle MF, Farine D, Grabowska K, Menticoglou S, Mundle W, Murphy-Kaulbeck L, Ouellet A, Pressey T, Roggensack A. Guidelines for the Management of Vasa Previa. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:748-753. [DOI: 10.1016/s1701-2163(16)34282-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Oyelese Y. Placenta previa: the evolving role of ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:123-126. [PMID: 19644942 DOI: 10.1002/uog.7312] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Lindqvist PG, Gren P. An easy-to-use method for detecting fetal hemoglobin—A test to identify bleeding from vasa previa. Eur J Obstet Gynecol Reprod Biol 2007; 131:151-3. [PMID: 16797824 DOI: 10.1016/j.ejogrb.2006.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 03/02/2006] [Accepted: 05/09/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vasa previa is a rare but potentially dangerous fetal condition that may occur during pregnancy. Ideally, all cases such cases are detected antenatally, but many present as late vaginal hemorrhaging. At the current time, there is no test for fetal hemoglobin (HbF) in general use. METHODS A modified method of identifying HbF is presented. Five milliliters of 0.14 M NaOH was combined with 50 microl of a mixture of fetal and maternal blood. After 2 min, it was judged if the solution still had a red tone or not. The sensitivity of this method for detecting HbF was assessed. RESULTS All 15 clinical personnel could identify both 69% and 34% HbF mixed with adult hemoglobin (100% sensitivity), 14 out of 15 could identify 17% HbF (93% sensitivity), and 12 out of 15 could identify a mixture containing 8% HbF (80% sensitivity). CONCLUSION Our rapid, simple test for HbF was at least as sensitive as slower, more cumbersome alkali denaturation tests in common use. It could prove to be a lifesaving tool in ruling out vasa previa bleeding in cases of unclear late pregnancy hemorrhages.
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Affiliation(s)
- Pelle G Lindqvist
- Department of Obstetrics and Gynecology, Clinical Sciences, Malmö University Hospital, Ingång 74, SE-20502 Malmö, Sweden.
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Olive EC, Roberts CL, Nassar N, Algert CS. Test characteristics of placental location screening by transabdominal ultrasound at 18-20 weeks. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 28:944-9. [PMID: 17121427 DOI: 10.1002/uog.3873] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine the test characteristics of a second-trimester transabdominal fetal anomaly scan in screening for placenta previa. PATIENTS AND METHODS This was a case-control study carried out at a tertiary obstetric hospital involving 54 women (0.5% of the total number booked for antenatal care and delivery at the center) with clinically significant placenta previa at the time of delivery, and 168 randomly selected controls who attended for antenatal care and delivery in 2000-2003. Sensitivity, specificity and false positive rate of the placenta-os measurement in the second-trimester transabdominal fetal anomaly scan for identification of clinically significant placenta previa were assessed. RESULTS Women with placenta previa at delivery had significantly different second-trimester placenta-os measurements from those of controls (P < 0.0001). For women with placenta previa, the mean (standard deviation) placenta-os measurement was -0.96 cm (1.95) vs. 4.15 cm (1.77) for controls (P < 0.0001). Using the anomaly scan as a screening test for placenta previa with a placenta-os measurement cut-off point of < or = 2 cm, all cases of placenta previa should be identified, but 11.1% (95% CI, 7.1-14.8) of women without placenta previa would have false positive results. At cut-off points of 3 cm and 1.5 cm the false positive rates were 25.7% (95% CI, 18.8-30.2%) and 6.6% (95% CI, 3.8-9.6%), respectively, but at 1.5 cm 3.8% of cases would be missed. CONCLUSIONS The second-trimester transabdominal fetal anomaly scan is a useful screening test for placenta previa. However, because of false positives among the much larger population of women without placenta previa, we estimate that with a cut-off point of < or =2 cm, 23 women would have to be followed up to confirm one true placenta previa.
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Affiliation(s)
- E C Olive
- Centre for Perinatal Health Services Research, School of Public Health, University of Sydney, Australia.
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Abstract
Benckiser's hemorrhage is a rare affection associated with 75-100% neonatal mortality. It is due to the rupture of one or more velamentous and previa vessels. We report two cases, one of which was fatal for the child despite immediate neonatal management. This illustrates how difficult the obstetrical and neonatal management of this affection is. Risk factors for velamentous insertion of the cord and vasa previa are multiple pregnancies, low lying placenta, bilobed and succenturiate-lobed placenta. First we specify the pathophyisiological implication of this severe hemorrhage, then the means to diagnose fetal bleeding or vasa previa. This knowledge could allow us to develop strategies to screen women sonographically to detect vasa previa. Unfortunately the benefits, risks, limits and cost of such strategies remain unknown.
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Affiliation(s)
- C Régis
- Clinique d'Obstétrique, Hôpital Jeanne de Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille Cedex.
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Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Farina A, Okai T. Velamentous cord insertion into the lower third of the uterus is associated with intrapartum fetal heart rate abnormalities. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:425-9. [PMID: 16479618 DOI: 10.1002/uog.2645] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To evaluate the accuracy of sonographic identification of the site of umbilical cord insertion (CI) at 18-20 weeks of gestation, to compare the sensitivities for detection of a velamentous cord insertion (VCI) secondary to a CI into the anterior, posterior or fundal wall, and to compare the intrapartum complications secondary to VCI into the upper, middle or lower third of the uterus. METHODS As part of the routine ultrasound scan at 18-20 weeks' gestation we evaluated abnormal CI (VCI and marginal CI) and the location of the CI in the uterus in 3446 pregnancies. In cases of abnormal CI, the location of the CI was further classified as being in the upper, middle or lower third of the uterus. After delivery, the placenta and the umbilical cord were examined and intrapartum complications were compared with the location of the CI. RESULTS The values for antenatal detection of VCI were: sensitivity, 25 of 40 (62.5%); positive predictive value, 25 of 25 (100%); and negative predictive value, 3406 of 3421 (99.6%). The sensitivity for cases in which the CI was located on the anterior wall was 12 of 13 (92.3%); when it was located on the posterior wall, the sensitivity was 11 of 22 (50.0%); and when it was fundal the sensitivity was 2 of 5 (40.0%). Variable decelerations were frequently observed with a VCI. In lower VCI cases, non-reassuring fetal heart rate patterns and emergency Cesarean sections occurred with a higher frequency than in cases with upper or middle VCI (P < 0.01). After delivery, the length of the aberrant vessels in cases of VCI by pathologic examination was 3.9 +/- 3.3 cm in the upper third, 4.7 +/- 4.6 cm in the middle third, and 10.6 +/- 6.8 cm in the lower third; thus, the aberrant vessel length was significantly greater when the CI was in the lower third of the uterus (P = 0.024). CONCLUSION We have demonstrated that VCI with a lower CI site and with longer aberrant vessels is associated with various intrapartum complications. This finding has the potential for improving perinatal outcome.
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Affiliation(s)
- J Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
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Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Okai T. Velamentous Cord Insertion: Significance of Prenatal Detection to Predict Perinatal Complications. Taiwan J Obstet Gynecol 2006; 45:21-5. [PMID: 17272203 DOI: 10.1016/s1028-4559(09)60185-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the maternal and child health statistics of Japan for 2003, perinatal deaths were most frequent in pregnant women with abnormalities of the placenta, umbilical cord, and fetal membrane. Despite advances in perinatal medicine, approximately 2% of low-risk pregnant women still require an emergency cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. In our previous studies, some abnormalities of the placenta and umbilical cord were associated with abnormalities of cord insertion. Furthermore, we reported that prenatal detection of velamentous cord insertion (VCI) reduced the number of emergency cesarean sections in low-risk women. In this review, we describe the prenatal detection of abnormalities of umbilical cord insertion and the management of VCI based on our current clinical data.
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Affiliation(s)
- Junichi Hasegawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
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Oyelese Y, Kontopoulos EV, Koscica K, Lashley S, Vintzileos AM. Sonographic diagnosis of asymptomatic cervical dilatation in a complete placenta previa. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1233-1234. [PMID: 15328441 DOI: 10.7863/jum.2004.23.9.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Yinka Oyelese
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 125 Paterson St, New Brunswick 08901, USA.
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Bhide A, Prefumo F, Moore J, Hollis B, Thilaganathan B. Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. BJOG 2003. [DOI: 10.1111/j.1471-0528.2003.02491.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current Awareness. Prenat Diagn 2001. [DOI: 10.1002/pd.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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