Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus - 20/11/24
, Ali Javinani, MD b, c, Brittany Gudanowski, BSc b, Eyal Krispin, MD b, Andrei Rebarber, MD d, e, f, Ranjit Akolekar, MD, MRCOG, PhD g, h, Val Catanzarite, MD, PhD i, Rohan D’Souza, MD, PhD, FRCOG j, k, Richard Bronsteen, MD l, Anthony Odibo, MD, MSCE m, Matthias A. Scheier, MD, MSc n, Junichi Hasegawa, MD, PhD o, Eric Jauniaux, MD, PhD, FRCOG, Dr(hc) p, Christoph Lees, MD q, r, s, Deepa Srinivasan, MBBS, DGO, MD, MRCOG q, Elizabeth Daly-Jones, MSc q, Gregory Duncombe, MBBS, CSCT(FMP), FRANZCOG, DDU, CMFM, Grad Cert App Law, GAICD t, Yaakov Melcer, MD u, v, Ron Maymon, MD u, v, Robert Silver, MD w, Federico Prefumo, MD, PhD x, Daisuke Tachibana, MD, PhD y, Wolfgang Henrich, MD z, aa, Robert Cincotta, MBBS, FRANZCOG, DDU, CMFM ab, Scott A. Shainker, DO, MS a, b, c, Angela C. Ranzini, MD ac, Ashley S. Roman, MD, MPH ad, Ramen Chmait, MD ae, Edgar A. Hernandez-Andrade, MD af, Daniel L. Rolnik, MD, PhD, MPH ag, Waldo Sepulveda, MD, FISUOG ah, Alireza A. Shamshirsaz, MD a, b, c, ⁎ Abstract |
Background |
There are limited data to guide the diagnosis and management of vasa previa. Currently, what is known is largely based on case reports or series and cohort studies.
Objective |
This study aimed to systematically collect and classify expert opinions and achieve consensus on the diagnosis and clinical management of vasa previa using focus group discussions and a Delphi technique.
Study Design |
A 4-round focus group discussion and a 3-round Delphi survey of an international panel of experts on vasa previa were conducted. Experts were selected on the basis of their publication record on vasa previa. First, we convened a focus group discussion panel of 20 experts and agreed on which issues were unresolved in the diagnosis and management of vasa previa. A 3-round anonymous electronic survey was then sent to the full expert panel. Survey questions were presented on the diagnosis and management of vasa previa, which the experts were asked to rate on a 5-point Likert scale (from “strongly disagree”=1 to “strongly agree”=5). Consensus was defined as a median score of 5. Following responses to each round, any statements that had median scores of ≤3 were deemed to have had no consensus and were excluded. Statements with a median score of 4 were revised and re-presented to the experts in the next round. Consensus and nonconsensus statements were then aggregated.
Results |
A total of 68 international experts were invited to participate in the study, of which 57 participated. Experts were from 13 countries on 5 continents and have contributed to >80% of published cohort studies on vasa previa, as well as national and international society guidelines. Completion rates were 84%, 93%, and 91% for the first, second, and third rounds, respectively, and 71% completed all 3 rounds. The panel reached a consensus on 26 statements regarding the diagnosis and key points of management of vasa previa, including the following: (1) although there is no agreement on the distance between the fetal vessels and the cervical internal os to define vasa previa, the definition should not be limited to a 2-cm distance; (2) all pregnancies should be screened for vasa previa with routine examination for placental cord insertion and a color Doppler sweep of the region over the cervix at the second-trimester anatomy scan; (3) when a low-lying placenta or placenta previa is found in the second trimester, a transvaginal ultrasound with Doppler should be performed at approximately 32 weeks to rule out vasa previa; (4) outpatient management of asymptomatic patients without risk factors for preterm birth is reasonable; (5) asymptomatic patients with vasa previa should be delivered by scheduled cesarean delivery between 35 and 37 weeks of gestation; and (6) there was no agreement on routine hospitalization, avoidance of intercourse, or use of 3-dimensional ultrasound for diagnosis of vasa previa.
Conclusion |
Through focus group discussion and a Delphi process, an international expert panel reached consensus on the definition, screening, clinical management, and timing of delivery in vasa previa, which could inform the development of new clinical guidelines.
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Key words : clinical guideline, clinical management, Delphi, expert consensus, practice guideline, prenatal diagnosis, survey, ultrasound, vasa previa
Plan
| Y.O. and A.J. share first authorship. |
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| R.D. has received funding through the International Vasa Previa Foundation for research unrelated to this study. The remaining authors report no conflict of interest. |
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| The authors report no funding for this study. |
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| A preliminary abstract of this study was presented at the 33rd World Congress of the International Society of Ultrasound in Obstetrics and Gynecology, Seoul, South Korea, October 16–19, 2023. |
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| Funding for open access was provided by Vasa Praevia Raising Awareness. The funder had no input in or influence on the manuscript. |
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| Cite this article as: Oyelese Y, Javinani A, Gudanowski B, et al. Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus. Am J Obstet Gynecol 2024;231:638.e1-24. |
Vol 231 - N° 6
P. 638.e1-638.e24 - décembre 2024 Retour au numéro
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