Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome.
OBJECTIVE: To describe the prenatal ultrasonographic diagnosis, natural evolution, and clinical outcomes of vasa previa in a large population at a single institution. METHODS: We attempted to view the internal cervical os of 93,874 women with second- and third-trimester pregnancies during an 8-year period. Echogenic parallel or circular lines near the cervix, seen by gray-scale ultrasonography, raised the possibility of vasa previa. Diagnosis was confirmed by Doppler and endovaginal studies if aberrant vessels over the internal cervical os were suspected. Abnormal placental morphology and velamentous cord insertion were documented if they were identified during prenatal scans. Ultrasonographic findings were correlated with clinical courses, perinatal outcomes, and placental pathology examinations. RESULTS: Eighteen cases of vasa previa were suspected at a mean (+/- standard deviation) gestational age of 26.0 +/- 6.3 weeks; the earliest diagnosis was at 15.6 weeks' gestation. Eight of those cases initially showed placental edge over the internal os and later developed vasa previa after the placenta "receded" from the cervix. Six women had mild vaginal bleeding at a mean gestational age of 31.3 weeks. Three women had normal late third-trimester scans and were allowed to have uncomplicated vaginal deliveries. The remaining subjects delivered by cesarean. There were two deaths (one fetal and one neonatal), and minor preterm complications slightly prolonged infant hospitalizations. One set of preterm twins needed neonatal transfusions. Pathology findings included ten cases of velamentous insertion and three cases each of bilobed placentas, succenturiate lobes, and marginal cord insertion. CONCLUSION: Vasa previa was detected in asymptomatic women as early as the second trimester. Perinatal outcome was generally favorable, although several infants had slightly extended newborn nursery admissions due to mild complications of prematurity.