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Cited by 75Maternal and fetal healthcareCongenital Anomalies and Fetal SurgeryPrenatal Screening and Diagnostics

Perinatal outcome of pregnancies with prenatal diagnosis of vasa previa: systematic review and meta‐analysis

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Zhang, W., Geris, S., Al‐Emara, N., Ramadan, G., Sotiriadis, A., Akolekar, R.·2021·Ultrasound in Obstetrics & Gynecology
DOI 10.1002/uog.22166
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Abstract

Objectives: To derive accurate estimates of perinatal survival in pregnancies with and without a prenatal diagnosis of vasa previa based on a systematic review of the literature and meta‐analysis. Methods: A search of MEDLINE, EMBASE and The Cochrane Library was performed to review relevant citations reporting on the perinatal outcomes of pregnancies with vasa previa. We included prospective and retrospective cohort and population studies that provided data on pregnancies with a prenatal diagnosis of vasa previa or cases diagnosed at birth or following postnatal placental examination. Meta‐analysis using a random‐effects model was performed to derive weighted pooled estimates of perinatal survival (excluding stillbirths and neonatal deaths) and intact perinatal survival (additionally excluding hypoxic morbidity). Incidence rate difference (IRD) meta‐analysis was used to estimate the significance of differences in pooled proportions between cases of vasa previa with and those without a prenatal diagnosis. Heterogeneity between studies was estimated using Cochran's Q and the I2 statistic. Results: We included 21 studies reporting on the perinatal outcomes of 683 pregnancies with a prenatal diagnosis of vasa previa. There were three stillbirths (1.01% (95% CI, 0.40–1.87%)), five neonatal deaths (1.19% (95% CI, 0.52–2.12%)) and 675 surviving neonates, resulting in a pooled estimate for perinatal survival of 98.6% (95% CI, 97.6–99.3%). Based on seven studies that included cases of vasa previa with and without a prenatal diagnosis, the pooled perinatal survival in pregnancies without a prenatal diagnosis (61/118) was 72.1% (95% CI, 50.6–89.4%) vs 98.6% (95% CI, 96.7–99.7%) in cases with a prenatal diagnosis (224/226). Therefore, the risk of perinatal death was 25‐fold higher when a diagnosis of vasa previa was not made antenatally, compared with when it was (odds ratio (OR), 25.39 (95% CI, 7.93–81.31); P < 0.0001). Similarly, the risk of hypoxic morbidity was increased 50‐fold in cases with vasa previa without a prenatal diagnosis compared with those with a prenatal diagnosis (36/61 vs 5/224; OR, 50.09 (95% CI, 17.33–144.79)). The intact perinatal survival rate in cases of vasa previa without a prenatal diagnosis was significantly lower than in those with a prenatal diagnosis (28.1% (95% CI, 14.1–44.7%) vs 96.7% (95% CI, 93.6–98.8%)) (IRD, 73.4% (95% CI, 53.9–92.7%); Z = –7.4066, P < 0.001). Conclusions: Prenatal diagnosis of vasa previa is associated with a high rate of perinatal survival, whereas lack of an antenatal diagnosis significantly increases the risk of perinatal death and hypoxic morbidity. Further research should be undertaken to investigate strategies for incorporating prenatal screening for vasa previa into routine clinical practice. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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  1. McNair AJ. Placenta praevia, with vasa praevia; Caesarean section. Proc R Soc Med 1921; 14: 195-196.
  2. Alment EA. Vasa praevia simulating antepartum hemorrhage. Br Med J 1949; 2: 1273.
  3. Oyelese KO, Turner M, Lees C, Campbell S. Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv 1999; 54: 138-145.
  4. Bronsteen R, Whitten A, Balasubramanian M, Lee W, Lorenz R, Redman M, Goncalves L, Seubert D, Bauer S, Comstock C. Vasa previa: clinical presentations, outcomes, and implications for management. Obstet Gynecol 2013; 122: 352-357.

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Authors
Zhang, W., Geris, S., Al‐Emara, N., Ramadan, G., Sotiriadis, A., & Akolekar, R.
Affiliations
  • Medway NHS Foundation Trust (GB)
  • Aristotle University of Thessaloniki (GR)
  • Canterbury Christ Church University (GB)
Corresponding author
Akolekar, R.
ORCID
Venue
Ultrasound in Obstetrics & Gynecology
Publisher
Wiley
Published
2021-05
Volume
57
Issue
5
Pages
710-719
ISSN
  • 0960-7692 (ISSN-L)
  • 1469-0705
DOI
10.1002/uog.22166
OpenAlex
W3046733751
Cited by
75
References
34
Citations by year
2026: 10 · 2025: 11 · 2024: 22 · 2023: 17 · 2022: 13 · 2021: 2
FWCI
1.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Ultrasound in Obstetrics and Gynecology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Canterbury Christ Church University
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
Keywords
vasa previa, prenatal diagnosis, perinatal outcomes, perinatal survival, stillbirth, neonatal death, hypoxic-ischemic encephalopathy, placental examination, fetal loss risk, placental abruption, placental insufficiency, fetal growth restriction, macrosomia, fetal hypoxia, fetal hypoglycemia
MeSH terms
Female, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Prenatal Diagnosis, Prospective Studies, Retrospective Studies, Perinatal Mortality, Vasa Previa

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