Variations in reported outcomes in studies on vasa previa: a systematic review

Villani, Linda A.; Pavalagantharajah, Sureka; D’Souza, Rohan

doi:10.1016/j.ajogmf.2020.100116

Cited by 13 publications

(9 citation statements)

References 119 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As others have noted, a more uniform reporting of cases will be critical to make further advances in the care of these high-risk pregnancies. 20,21 It is possible that there is limited duplicate reporting of cases. For example, the report of Oyelese et al 22 included cases from the Vasa Previa Foundation, and it is unknown whether any of these cases might have been captured in other case series.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa

Heyborne

2023

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

OBJECTIVE: To determine the causes and potential preventability of perinatal deaths in prenatally identified cases of vasa previa. DATA SOURCES: Reports of prenatally identified cases of vasa previa published in the English language literature since 2000 were identified in Medline and ClinicalTrials.gov with the search terms “vasa previa,” “abnormal cord insertion,” “velamentous cord,” “marginal cord,” “bilobed placenta,” and “succenturiate lobe.” METHODS OF STUDY SELECTION: All cases from the above search with an antenatally diagnosed vasa previa present at delivery in singleton or twin gestations with perinatal mortality information were included. TABULATION, INTEGRATION, AND RESULTS: Cases meeting inclusion criteria were manually abstracted, and multiple antenatal, intrapartum, and outcome variables were recorded. Deaths and cases requiring neonatal transfusion were analyzed in relation to plurality, routine hospitalization, and cervical length monitoring. A total of 1,109 prenatally diagnosed cases (1,000 singletons, 109 twins) were identified with a perinatal mortality rate attributable to vasa previa of 1.1% (95% CI 0.6–1.9%). All perinatal deaths occurred with unscheduled deliveries. The perinatal mortality rate in twin pregnancies was markedly higher than that in singleton pregnancies (9.2% vs 0.2%, P<.001), accounting for 80% of overall mortality despite encompassing only 9.8% of births. Compared with individuals with singleton pregnancies, those with twin pregnancies are more likely to undergo unscheduled delivery (56.4% vs 35.1%, P=.01) despite delivering 2 weeks earlier (33.2 weeks vs 35.1 weeks, P=.006). An institutional policy of routine hospitalization is associated with a reduced need for neonatal transfusion (0.9% vs 6.0%, P<.001) and a reduction in the perinatal mortality rate in twin pregnancies (0% vs 25%, P=.002) but not in singleton pregnancies (0% vs 0.5%, P=.31). CONCLUSION: Routine hospitalization and earlier delivery of twins may result in a reduction in the perinatal mortality rate. A smaller benefit from routine admission of individuals with singleton pregnancies cannot be excluded. There is currently insufficient evidence to recommend the routine use of cervical length measurements to guide clinical management.

show abstract

Section: Discussionmentioning

confidence: 99%

Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa

Heyborne

2023

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…Further, Villani et al demonstrated that reporting of outcomes in VP studies have been limited and highly variable, with most studies including data related to clinical outcomes (eg, fetal heart rate, birth weight, need for transfusion) and very little exploration of outcomes such as maternal and fetal life impact, perception of care, or health resource utilization beyond the immediate peripartum period 23 . Future practice guidelines will benefit from rich and descriptive data surrounding the impacts of institutions' chosen screening protocols, whatever they may be, and even small reports with careful consideration of the factors that can impact decision‐making will be of great value in amassing necessary data.…”

Section: Discussionmentioning

confidence: 99%

Impact of Universal Vasa Previa Screening With Color Doppler During the OB Ultrasound Anatomy Scan

Bihun,

Trinidad,

Packard

2023

J of Ultrasound Medicine

View full text Add to dashboard Cite

ObjectivesOur institution introduced universal vasa previa (VP) screening utilizing transabdominal ultrasound with color Doppler for all pregnancies at the second trimester anatomy scan. Our study sought to describe the clinical impact of this intervention.MethodsRadiology records from the 12 months pre‐ and post‐intervention were queried for “vasa previa.” Records included for analysis were those with a first‐time diagnosis or discussion of VP at the anatomy scan. Cases were categorized by outcome: (Group 1) True VP, with subgroups A, unresolved by time of delivery and B, resolved by delivery; (Group 2) False positives; (Group 3) Possible VP without definitive diagnosis; and (Group 4) VP ruled out, for example, “no features of VP.” Group size was expressed as a percentage of total anatomy scans during pre‐ or post‐intervention periods respectively. Absolute and relative percent change were calculated for each group.ResultsIn the pre‐intervention period, 1 case (0.36% of total scans) was categorized in Group 1A, 1 case (0.36%) in Group 3, and 7 cases (2.53%) in Group 4. In the post‐intervention period, 2 cases (0.30%) were in Group 1A, 4 cases (0.61%) in Group 1B, 2 cases (0.30%) in Group 2, 1 case (0.15%) in Group 3, and 7 cases (1.06%) in Group 4. There was a +153% relative change in true positives, from 0.36 to 0.91%.ConclusionsUniversal color Doppler screening may have increased detection (sensitivity) while simultaneously increasing false positives (decreased specificity). While decreasing sensitivity is not ideal, this is acceptable given the potential catastrophic outcome of a missed VP.

show abstract

“…We believe that a sample of 10 people to be sufficient for this step. After piloting, the survey will be made available online (through links on social media) and widely distributed through identified listservers of relevant organisations, including but not restricted to the Cochrane Pregnancy and Childbirth Group (30 members), the Global Obstetric Network (237 members), Core Outcomes in Women’s and Newborn Health (CrOWN) initiative (77 members), corresponding authors of publications on vasa previa included in a recent systematic review, 23 IVPF, United Kingdom Obstetric Surveillance System ( https://www.npeu.ox.ac.uk/ukoss ), UK Vasa Praevia Raising Awareness Trust ( http://vasapraevia.co.uk ), Australasian Maternity Outcomes Surveillance System ( https://www.amoss.com.au ), Perinatal Society of Australia and New Zealand ( https://www.psanz.com.au ) and Vasa Praevia Support and Awareness Ireland ( https://www.facebook.com/vasapraeviasupportandawarenessIreland ). We will aim to recruit at least 25 individuals from each stakeholder group to ensure an appropriate degree of representation.…”

Section: Methods and Analysismentioning

confidence: 99%

Core outcome set for studies on pregnant women with vasa previa (COVasP): a study protocol

et al. 2020

Self Cite

View full text Add to dashboard Cite

IntroductionVasa previa is a condition where fetal blood vessels run unprotected in the membranes, outside the umbilical cord, and cross the internal opening of the cervix. During rupture of membranes, these vessels can rupture and put the baby at serious risk of severe blood loss and death. Numerous studies are being conducted to improve diagnostic modalities and establish clear management plans to improve pregnancy outcomes. However, the lack of a standardised set of outcomes for studies on vasa previa makes it difficult to compare study findings and draw meaningful conclusions. Through this project, we will be developing a core outcome set for studies on pregnant women with vasa previa (COVasP).Methods and analysisThe development of COVasP will involve five steps. The first will be a systematic review, in which we will generate a long list of outcomes based on published studies in pregnancies complicated with vasa previa. The second will involve in-depth interviews with current and former patients, their family members and healthcare providers who care for these patients. This will be followed by a two-round Delphi survey, which will aim to narrow down the long list of outcomes into those considered important by four groups of ‘stakeholders’: (1) patients, family members and patient advocates/representatives, (2) healthcare providers, (3) researchers, epidemiologists and methodologists and (4) other stakeholders directly or indirectly involved in the management of these pregnancies such as administrators, guideline developers and policymakers. The fourth step will involve a face-to-face consensus meeting using a nominal group approach to establish a finalised core outcome set. The final step will involve measuring and defining the identified outcomes using a combination of systematic reviews and Delphi surveys.Ethics and disseminationThis study as well as consent forms for stakeholder participation have received approval from the Mount Sinai Hospital Research Ethics Board (REB number 18-0173-E) on 05 September 2018 and the Human Research Ethics Committee at The University of Technology Sydney, Australia on 30 July 2019 (UTS HREC reference number ETH19-3718). All progress will be documented on the international prospective register of systematic reviews and Core Outcome Measures in Effectiveness Trials databases.Registration detailshttp://www.comet-initiative.org/studies/details/1117.

show abstract

Variations in reported outcomes in studies on vasa previa: a systematic review

Cited by 13 publications

References 119 publications

Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa

Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa

Impact of Universal Vasa Previa Screening With Color Doppler During the OB Ultrasound Anatomy Scan

Core outcome set for studies on pregnant women with vasa previa (COVasP): a study protocol

Contact Info

Product

Resources

About