Vasa previa: updated guidelines from the Royal College of Obstetricians and Gynaecologists

  • Jauniaux E & al.
  • BJOG
  • 27 Sep 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Updated guidelines addressing vasa previa management have been published by the Royal College of Obstetricians and Gynaecologists.

  Why this matters

  • Vasa previa occurs when the fetal vessels run through the placental membranes, increasing risk for fetal exsanguination following rupture of membranes in active labor or with amniotomy.
  • Vasa previa is rare (1 in 1200 to 1 in 5000 pregnancies) but life-threatening (at least 60% fetal mortality after rupture of placental membranes).

Key recommendations

  • Routine fetal anatomy ultrasound has a high diagnostic accuracy and low false-positive rate in diagnosis of vasa previa.
  • A combination of both transabdominal and transvaginal color Doppler imaging provides the best diagnostic accuracy.
  • Evidence is unsufficient to support universal screening.
  • In the presence of vasa previa in the third trimester, elective cesarean delivery should be carried out prior to the onset of labor.
  • In the presence of vasa previa and preterm premature rupture of membranes and or preterm labor, a cesarean section should be immediately performed.
  • Planned delivery at 34-36 gestational weeks is reasonable in asymptomatic women.
  • Corticosteroids should be considered from 32 weeks.

Study design

  • Literature review and expert commentary.
  • Funding: None disclosed.

Limitations

  • Related to limitations of prior research.

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