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Incidence of and risk indicators for vasa praevia: a systematic review
Open accessAbstract
Background: Vasa praevia (VP) is a rare phenomenon that is assumed to increase the risk of severe complications, including fetal death. Critical data on its incidence are lacking, so there is no rational basis for prenatal screening. Objectives: To review the literature on the incidence and risk indicators for VP. Search strategy: We searched OVID MEDLINE, OVID EMBASE, the Cochrane Library and PubMed for case–control and cohort studies on incidence and risk indicators for VP. Selection criteria: Two reviewers selected studies and scored their methodological quality. Data collection and analysis: We calculated the mean incidence of VP. We constructed 2 × 2 tables cross‐classifying potential risk indicators against the incidence of VP to calculate common odds ratios and 95% confidence intervals, using the Mantel–Haenszel method. Main results: We included 13 studies (two prospective cohort studies, ten retrospective cohort studies and one case–control study) reporting on 569 410 patients with 325 cases of VP. Based on ten included cohort studies providing information on the incidence, the mean incidence of VP was 0.60 per 1000 pregnancies. We identified five different risk indicators and markers for VP: second‐trimester placenta praevia, conception by assisted reproductive technologies, a bilobed or succenturiate placenta, umbilical cord insertion in the lower third part of the uterus at first‐trimester ultrasound and velamentous cord insertion. Almost 83% of the cases of VP had one or more risk indicators. Authors' conclusions: In view of the low incidence, screening for VP in an unselected population is not advised. Targeted screening of women with one or more risk indicators as a part of routine mid‐gestation scanning should be considered. Tweetable abstract: Vasa praevia is more common in placenta praevia, conception by ART, velamentous cord insertion and bilobed placenta.
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“Risk factors for vasa previa include twin pregnancy, conception by assisted reproductive technology, a low-lying or bilobed placenta, succenturiate placental lobes and velamentous cord insertion 95 .”
From ISUOG Practice Guidelines (updated): performance of the routine mid‐trimester fetal ultrasound scan (2022) · cites this paper as [95]
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Golyanovskiy, O. V., Dyadyk, O., Oshovskyy, V., Geint, N. E., Мехедко, В. В., & Kachur, O. Y. (2021) · Reproductive health of woman · doi:10.30841/2708-8731.4.2021.238158 · Cited by 3
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Krief, D., Naepels, P., & Chevreau, J. (2018) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2018.10.056 · Cited by 3
Koorn, I., Jansen, C. H. J. R., Denswil, N. P., Wortelboer, E. J., & Pajkrt, E. (2025) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2025.114534 · Cited by 2
Self-citationVasa previa, diagnóstico prenatal y manejo obstétrico
Viñas, A. F., Hernandez, J., Manso, S. D. M., Mansilla, P. S., Colomo, C. Á., & Martín, J. I. G. (2019) · Clínica e Investigación en Ginecología y Obstetricia · doi:10.1016/j.gine.2019.06.002 · Cited by 2
Greenwood, L., Mastrobattista, J. M., Mack, L. M., Fox, K. A., Lee, W., & Donepudi, R. (2023) · Journal of Ultrasound in Medicine · doi:10.1002/jum.16220 · Cited by 2
Directive clinique no 402 : Placenta prævia : Diagnostic et prise en charge
Jain, V., Bos, H., & Bujold, E. (2020) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2020.05.001 · Cited by 2
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Trilla, C., Garrido‐Giménez, C., & Llurba, E. (2022) · Obstetrics & Gynecology International Journal · doi:10.15406/ogij.2022.13.00655 · Cited by 2
Shiro, M., Kiyose, M., Suzuki, Y., Sano, Y., Ikagawa, S., & Yoshida, S. (2023) · Case Reports in Women s Health · doi:10.1016/j.crwh.2023.e00558 · Cited by 1
Incidence and outcomes of vasa praevia in the United Kingdom
Attilakos, G., David, A. L., Tunn, R., Knight, M., & Brocklehurst, P. (2024) · NIHR Open Research · doi:10.3310/nihropenres.13696.2 · Cited by 1
Eyo, N. M., & Effiong, I. A. (2025) · Global Journal of Pure and Applied Sciences · doi:10.4314/gjpas.v31i3.14 · Cited by 1
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Spontaneous Resolution of Vasa Previa and a Placental Shelf Detected at 19 Weeks of Gestation
Miyake, T. M., Takayoshi, R., Koyanagi, A., Kawahara, T., Konishi, M., Hata, T., & Itoh, A. (2022) · Donald School Journal of Ultrasound in Obstetrics & Gynecology · doi:10.5005/jp-journals-10009-1941 · Cited by 1
A Case of Velamentous Umbilical Cord Insertion with Vasa Praeviaand Literature Review
李, 欣. (2023) · Medical Diagnosis · doi:10.12677/md.2023.132030 · Cited by 1
Thanasa, E., Thanasa, A., Antoniou, I.-R., Gerokostas, E.-E., Kontogeorgis, G., Leroutsos, A., Papadoulis, V., Simou, A., Chasiotis, A., & Thanasas, I. (2024) · Cureus · doi:10.7759/cureus.58575 · Cited by 1
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Ruiter, L., Mol, B. W., & Pajkrt, E. (2016) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14015 · Cited by 1
Self-citationThe mid-gestation triple test profile among women diagnosed with vasa previa
Melcer, Y., Maymon, R., Pekar‐Zlotin, M., Tovbin, J., Smorgick, N., Cuckle, H., & Sharony, R. (2017) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2017.1317343 · Cited by 1
Detection of vasa praevia in the mid‐trimester ultrasound by Australian sonographers
Humphries‐Hart, F., Davies, B., Bethune, M., & Saxton, V. (2019) · Sonography · doi:10.1002/sono.12191 · Cited by 1
Vasa praevia diagnosis in the mid trimester ultrasound
Humphries‐Hart, F., Bethune, M., & Saxton, V. (2020) · Sonography · doi:10.1002/sono.12222 · Cited by 1
Prevalence of Extraplacental Anastomoses in Monochorionic Twin Pregnancies
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Liu, Q., Zhang, Q., & Liu, P. (2022) · Journal of Environmental and Public Health · doi:10.1155/2022/1685783 · Cited by 1
RetractedWeerakkody, Y., Schmidt, R., & Campos, A. (2011) · Radiopaedia.org · doi:10.53347/rid-13131 · Cited by 1
Placenta Previa and Related Disorders
Oyelese, Y. (2023) · Wiley eBooks · doi:10.1002/9781119636540.ch43 · Cited by 1
Metadata
- Authors
- Ruiter, L., Kok, N., Limpens, J., Derks, J., de Graaf, I., Mol, B., & Pajkrt, E.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Vrije Universiteit Amsterdam (NL)
- Department of Obstetrics and Gynaecology University Medical Centre Utrecht the Netherlands
- Department of Obstetrics and Gynaecology Academic Medical Centre Amsterdam Amsterdam the Netherlands
- The Robinson Institute School of Paediatrics and Reproductive Health University of Adelaide Adelaide SA Australia
- Corresponding author
- Ruiter, L
- ORCID
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2015-12-23
- Volume
- 123
- Issue
- 8
- Pages
- 1278-1287
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2203564449
- Cited by
- 141
- References
- 36
- Citations by year
- 2026: 15 · 2025: 6 · 2024: 13 · 2023: 18 · 2022: 14 · 2021: 12 · 2020: 19 · 2019: 16 · 2018: 13 · 2017: 9 · 2016: 4
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Funders
- Academic Medical Centre in Amsterdam
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Surgery › Congenital Anomalies and Fetal Surgery
- Keywords
- vasa previa, incidence, risk factors, placenta previa, assisted reproduction, velamentous cord insertion, umbilical cord insertion, prenatal screening, fetal death
- MeSH terms
- Female, Humans, Placenta, Placenta Previa, Pregnancy, Pregnancy Trimester, First, Pregnancy Trimester, Second, Risk, Umbilical Cord, Odds Ratio, Ultrasonography, Prenatal, Risk Assessment, Reproductive Techniques, Assisted, Vasa Previa
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