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Yinka Oyelese - One of the best experts on this subject based on the ideXlab platform.
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Vasa Previa prenatal diagnosis and outcomes thirty five cases from a single maternal fetal medicine practice
Journal of Ultrasound in Medicine, 2018Co-Authors: Ankita Kulkarni, Jennifer E Powel, Michael Aziz, Leena Shah, Susan Lashley, Carlos W Benito, Yinka OyeleseAbstract:OBJECTIVES To assess the accuracy and effectiveness of routine screening for Vasa Previa, to describe our experience, and to assess factors that contribute to missed cases of Vasa Previa. METHODS A retrospective descriptive study of all cases of Vasa Previa from a single maternal-fetal medicine service between 2009 and 2017 was performed. Ultrasound findings and obstetric and neonatal outcomes were reviewed and analyzed. RESULTS Thirty-five cases of Vasa Previa were identified. Most cases (33 of 35 [94.3%]) were diagnosed antenatally. All 33 cases that followed our screening protocol were diagnosed antenatally and had favorable outcomes. Two cases that did not follow our protocol were not diagnosed antenatally and were delivered emergently. The mean gestational age ± SD at delivery of antenatally diagnosed cases was 34.9 ± 1.69 weeks. All neonates survived. CONCLUSIONS Routine ultrasound screening for Vasa Previa using American Institute of Ultrasound in Medicine criteria will almost universally lead to good outcomes and prevent perinatal mortality.
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Vasa Previa diagnosis clinical practice and outcomes in australia
Obstetrics & Gynecology, 2017Co-Authors: Elizabeth A Sullivan, Nasrin Javid, Gregory J Duncombe, Nadom Safi, Robert Cincotta, Caroline S E Homer, Lesley E Halliday, Yinka OyeleseAbstract:OBJECTIVE:To estimate the incidence of women with Vasa Previa in Australia and to describe risk factors, timing of diagnosis, clinical practice, and perinatal outcomes.METHODS:A prospective population-based cohort study was undertaken using the Australasian Maternity Outcomes Surveillance System bet
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placenta Previa placenta accreta and Vasa Previa
Obstetrics & Gynecology, 2006Co-Authors: Yinka Oyelese, John C SmulianAbstract:Placenta Previa, placenta accreta, and Vasa Previa are important causes of bleeding in the second half of pregnancy and in labor. Risk factors for placenta Previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. The diagnostic modality of choice for placenta Previa is transvaginal ultrasonography, and women with a complete placenta Previa should be delivered by cesarean. Small studies suggest that, when the placenta to cervical os distance is greater than 2 cm, women may safely have a vaginal delivery. Regional anesthesia for cesarean delivery in women with placenta Previa is safe. Delivery should take place at an institution with adequate blood banking facilities. The incidence of placenta accreta is rising, primarily because of the rise in cesarean delivery rates. This condition can be associated with massive blood loss at delivery. Prenatal diagnosis by imaging, followed by planning of peripartum management by a multidisciplinary team, may help reduce morbidity and mortality. Women known to have placenta accreta should be delivered by cesarean, and no attempt should be made to separate the placenta at the time of delivery. The majority of women with significant degrees of placenta accreta will require a hysterectomy. Although successful conservative management has been described, there are currently insufficient data to recommend this approach to management routinely. Vasa Previa carries a risk of fetal exsanguination and death when the membranes rupture. The condition can be diagnosed prenatally by ultrasound examination. Good outcomes depend on prenatal diagnosis and cesarean delivery before the membranes rupture. (Obstet Gynecol 2006;107:927–41)
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placenta Previa placenta accreta and Vasa Previa
Obstetrics & Gynecology, 2006Co-Authors: Yinka Oyelese, John C SmulianAbstract:Placenta Previa, placenta accreta, and Vasa Previa are important causes of bleeding in the second half of pregnancy and in labor. Risk factors for placenta Previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. The diagnostic modality of choice for placenta Previa is transvaginal ultrasonography, and women with a complete placenta Previa should be delivered by cesarean. Small studies suggest that, when the placenta to cervical os distance is greater than 2 cm, women may safely have a vaginal delivery. Regional anesthesia for cesarean delivery in women with placenta Previa is safe. Delivery should take place at an institution with adequate blood banking facilities. The incidence of placenta accreta is rising, primarily because of the rise in cesarean delivery rates. This condition can be associated with massive blood loss at delivery. Prenatal diagnosis by imaging, followed by planning of peripartum management by a multidisciplinary team, may help reduce morbidity and mortality. Women known to have placenta accreta should be delivered by cesarean, and no attempt should be made to separate the placenta at the time of delivery. The majority of women with significant degrees of placenta accreta will require a hysterectomy. Although successful conservative management has been described, there are currently insufficient data to recommend this approach to management routinely. Vasa Previa carries a risk of fetal exsanguination and death when the membranes rupture. The condition can be diagnosed prenatally by ultrasound examination. Good outcomes depend on prenatal diagnosis and cesarean delivery before the membranes rupture.
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three dimensional sonographic diagnosis of Vasa Previa
Ultrasound in Obstetrics & Gynecology, 2004Co-Authors: Yinka Oyelese, John C Smulian, Eftichia V Kontopoulos, Martin R Chavez, Lami Yeo, Gregg Giannina, W E ScorzaAbstract:Vasa Previa is said to occur when fetal vessels run in the membranes over the cervix, below the presenting part, without the support of placental tissue or umbilical cord1. Rupture of these vessels at the time of spontaneous or artificial rupture of the membranes not infrequently results in fetal exsanguination and death1. When the diagnosis is not made prenatally, over half of fetuses die, and median Apgar scores in survivors are low (median, 1 at 1 min and 4 at 5 min)2. In addition, over half of these survivors require neonatal blood transfusions2. Thus, a good outcome depends primarily on prenatal diagnosis by ultrasound and elective delivery before the membranes rupture1–8. Two variants of Vasa Previa have been described: Type 1 results from velamentous insertion of the cord, and Type 2 from vessels running between two lobes of a bilobed or succenturiate placenta3. Pregnancies with second-trimester low-lying placentae, placentae with accessory lobes, multiple pregnancies, and those resulting from in-vitro fertilization have previously been described as being at risk for Vasa Previa. Women with such conditions may benefit from routine prenatal determination of the placental cord insertion site1–3,5–7. We describe here the prenatal diagnosis and evaluation of Vasa Previa using three-dimensional (3D) sonography. In the first case, two-dimensional (2D) transvaginal sonography was performed on a woman at 30 weeks’ gestation because a bilobed placenta had been seen on 2D transabdominal sonography. Vasa Previa was suspected. We then performed 3D transvaginal sonography with color and power Doppler using a Voluson Expert 730 (GE Medical Systems, Milwaukee, WI, USA) ultrasound machine. These confirmed the diagnosis of Vasa Previa. 3D multiplanar views revealed that a vessel overran the cervix in the anterior–posterior sagittal direction (Figures 1–3). The diagnosis of Vasa Previa and a bilobed placenta were confirmed at Cesarean delivery at 35 weeks’ gestation (Figure 4). Both mother and baby did well. In the second case, a 37-year-old woman was referred to our hospital at a gestational age of 24 weeks with a diagnosis of complete placenta Previa and vaginal bleeding. Sonography at our center revealed an appropriately grown singleton live fetus, with normal amniotic fluid volume. On initial 2D transabdominal and transvaginal sonography, there appeared to be complete placenta Previa. It was noted that the placental edge was just slightly to the right of the internal cervical os. When a mid-sagittal view of the cervix was obtained with 3D ultrasound, it became apparent that there were vessels overlying the cervix in an anterior–posterior direction, running through the membranes just along the lateral placental edge. Pulsed Doppler demonstrated a fetal umbilical arterial signal through these vessels. The patient was admitted to hospital. Steroids were administered for lung maturation and she was kept under close surveillance. At 33 weeks’ gestation, followup 3D transvaginal sonography was performed with color and power Doppler. Multiplanar imaging confirmed the diagnosis of Vasa Previa (Figures 5 and 6). An uncomplicated Cesarean delivery was performed at
John C Smulian - One of the best experts on this subject based on the ideXlab platform.
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placenta Previa placenta accreta and Vasa Previa
Obstetrics & Gynecology, 2006Co-Authors: Yinka Oyelese, John C SmulianAbstract:Placenta Previa, placenta accreta, and Vasa Previa are important causes of bleeding in the second half of pregnancy and in labor. Risk factors for placenta Previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. The diagnostic modality of choice for placenta Previa is transvaginal ultrasonography, and women with a complete placenta Previa should be delivered by cesarean. Small studies suggest that, when the placenta to cervical os distance is greater than 2 cm, women may safely have a vaginal delivery. Regional anesthesia for cesarean delivery in women with placenta Previa is safe. Delivery should take place at an institution with adequate blood banking facilities. The incidence of placenta accreta is rising, primarily because of the rise in cesarean delivery rates. This condition can be associated with massive blood loss at delivery. Prenatal diagnosis by imaging, followed by planning of peripartum management by a multidisciplinary team, may help reduce morbidity and mortality. Women known to have placenta accreta should be delivered by cesarean, and no attempt should be made to separate the placenta at the time of delivery. The majority of women with significant degrees of placenta accreta will require a hysterectomy. Although successful conservative management has been described, there are currently insufficient data to recommend this approach to management routinely. Vasa Previa carries a risk of fetal exsanguination and death when the membranes rupture. The condition can be diagnosed prenatally by ultrasound examination. Good outcomes depend on prenatal diagnosis and cesarean delivery before the membranes rupture. (Obstet Gynecol 2006;107:927–41)
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placenta Previa placenta accreta and Vasa Previa
Obstetrics & Gynecology, 2006Co-Authors: Yinka Oyelese, John C SmulianAbstract:Placenta Previa, placenta accreta, and Vasa Previa are important causes of bleeding in the second half of pregnancy and in labor. Risk factors for placenta Previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. The diagnostic modality of choice for placenta Previa is transvaginal ultrasonography, and women with a complete placenta Previa should be delivered by cesarean. Small studies suggest that, when the placenta to cervical os distance is greater than 2 cm, women may safely have a vaginal delivery. Regional anesthesia for cesarean delivery in women with placenta Previa is safe. Delivery should take place at an institution with adequate blood banking facilities. The incidence of placenta accreta is rising, primarily because of the rise in cesarean delivery rates. This condition can be associated with massive blood loss at delivery. Prenatal diagnosis by imaging, followed by planning of peripartum management by a multidisciplinary team, may help reduce morbidity and mortality. Women known to have placenta accreta should be delivered by cesarean, and no attempt should be made to separate the placenta at the time of delivery. The majority of women with significant degrees of placenta accreta will require a hysterectomy. Although successful conservative management has been described, there are currently insufficient data to recommend this approach to management routinely. Vasa Previa carries a risk of fetal exsanguination and death when the membranes rupture. The condition can be diagnosed prenatally by ultrasound examination. Good outcomes depend on prenatal diagnosis and cesarean delivery before the membranes rupture.
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three dimensional sonographic diagnosis of Vasa Previa
Ultrasound in Obstetrics & Gynecology, 2004Co-Authors: Yinka Oyelese, John C Smulian, Eftichia V Kontopoulos, Martin R Chavez, Lami Yeo, Gregg Giannina, W E ScorzaAbstract:Vasa Previa is said to occur when fetal vessels run in the membranes over the cervix, below the presenting part, without the support of placental tissue or umbilical cord1. Rupture of these vessels at the time of spontaneous or artificial rupture of the membranes not infrequently results in fetal exsanguination and death1. When the diagnosis is not made prenatally, over half of fetuses die, and median Apgar scores in survivors are low (median, 1 at 1 min and 4 at 5 min)2. In addition, over half of these survivors require neonatal blood transfusions2. Thus, a good outcome depends primarily on prenatal diagnosis by ultrasound and elective delivery before the membranes rupture1–8. Two variants of Vasa Previa have been described: Type 1 results from velamentous insertion of the cord, and Type 2 from vessels running between two lobes of a bilobed or succenturiate placenta3. Pregnancies with second-trimester low-lying placentae, placentae with accessory lobes, multiple pregnancies, and those resulting from in-vitro fertilization have previously been described as being at risk for Vasa Previa. Women with such conditions may benefit from routine prenatal determination of the placental cord insertion site1–3,5–7. We describe here the prenatal diagnosis and evaluation of Vasa Previa using three-dimensional (3D) sonography. In the first case, two-dimensional (2D) transvaginal sonography was performed on a woman at 30 weeks’ gestation because a bilobed placenta had been seen on 2D transabdominal sonography. Vasa Previa was suspected. We then performed 3D transvaginal sonography with color and power Doppler using a Voluson Expert 730 (GE Medical Systems, Milwaukee, WI, USA) ultrasound machine. These confirmed the diagnosis of Vasa Previa. 3D multiplanar views revealed that a vessel overran the cervix in the anterior–posterior sagittal direction (Figures 1–3). The diagnosis of Vasa Previa and a bilobed placenta were confirmed at Cesarean delivery at 35 weeks’ gestation (Figure 4). Both mother and baby did well. In the second case, a 37-year-old woman was referred to our hospital at a gestational age of 24 weeks with a diagnosis of complete placenta Previa and vaginal bleeding. Sonography at our center revealed an appropriately grown singleton live fetus, with normal amniotic fluid volume. On initial 2D transabdominal and transvaginal sonography, there appeared to be complete placenta Previa. It was noted that the placental edge was just slightly to the right of the internal cervical os. When a mid-sagittal view of the cervix was obtained with 3D ultrasound, it became apparent that there were vessels overlying the cervix in an anterior–posterior direction, running through the membranes just along the lateral placental edge. Pulsed Doppler demonstrated a fetal umbilical arterial signal through these vessels. The patient was admitted to hospital. Steroids were administered for lung maturation and she was kept under close surveillance. At 33 weeks’ gestation, followup 3D transvaginal sonography was performed with color and power Doppler. Multiplanar imaging confirmed the diagnosis of Vasa Previa (Figures 5 and 6). An uncomplicated Cesarean delivery was performed at
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Vasa Previa the impact of prenatal diagnosis on outcomes
Obstetrics & Gynecology, 2004Co-Authors: Yinka Oyelese, Susan Lashley, Val Catanzarite, F Prefumo, Morey Schachter, Yosi Tovbin, Victoria Goldstein, John C SmulianAbstract:OBJECTIVE:To evaluate outcomes and predictors of neonatal survival in pregnancies complicated by Vasa Previa and to compare outcomes in prenatally diagnosed cases of Vasa Previa with those not diagnosed prenatally.METHODS:We performed a multicenter study of 155 pregnancies complicated by Vasa Previa
Ron Maymon - One of the best experts on this subject based on the ideXlab platform.
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Vasa Previa prenatal diagnosis and management
Current Opinion in Obstetrics & Gynecology, 2018Co-Authors: Yaakov Melcer, Ron Maymon, Eric JauniauxAbstract:PURPOSE AND VIEW: Vasa Previa is a rare disorder of placentation associated with a high rate of perinatal morbidity and mortality when undetected before delivery. We have evaluated the recent evidence for prenatal diagnosis and management of Vasa Previa. RECENT FINDINGS: Around 85% of cases of Vasa Previa have one or more identifiable risk factors including in-vitro fertilization, multiple gestations, bilobed, succenturiate or low-lying placentas, and velamentous cord insertion. The development of standardized prenatal targeted scanning protocols may improve perinatal outcomes. There is no clear consensus on the optimal surveillance strategy including the need for hospitalization, timing of corticosteroids administration and the value of transvaginal cervical length measurements. Outpatient management is possible if there is no evidence of cervical shortening on ultrasound and there are no symptoms of bleeding or uterine contractions. Recent national guidelines and expert reviews have recommended scheduled cesarean section of all asymptomatic women presenting with Vasa Previa between 34 and 36 weeks’ gestation. SUMMARY: Prenatal diagnosis of Vasa Previa is pivotal to prevent intrapartum fetal death. Although there is insufficient evidence to support the universal mid-gestation ultrasound screening for Vasa Previa, recent evidence indicates the need for standardized prenatal targeted screening protocols of pregnancies at high-risk of Vasa Previa.
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the mid gestation triple test profile among women diagnosed with Vasa Previa
Journal of Maternal-fetal & Neonatal Medicine, 2018Co-Authors: Yaakov Melcer, Marina Pekarzlotin, Ron Maymon, Josef Tovbin, Noam Smorgick, Howard Cuckle, Reuven SharonyAbstract:Purpose: To assess the mid-trimester triple test biomarkers among women diagnosed with Vasa Previa (VP).Methods: The study included 43 singleton pregnancies diagnosed with Vasa Previa between the y...
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impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or Vasa Previa
American Journal of Obstetrics and Gynecology, 2018Co-Authors: Yaakov Melcer, Eric Jauniaux, Shlomit Maymon, Anna Tsviban, Marina Pekarzlotin, Moshe Betser, Ron MaymonAbstract:Background Placenta accreta spectrum and Vasa Previa (VP) are congenital disorders of placentation associated with high morbidity and mortality for both mothers and newborns when undiagnosed before delivery. Prenatal diagnosis of these conditions is essential to allow multidisciplinary management and thus improve perinatal outcomes. Objective The objective of the study was to compare perinatal outcome in women with placenta accreta spectrum or Vasa Previa before and after implementation of targeted scanning protocols. Study Design This retrospective study included 2 nonconcurrent cohorts for each condition before and after implementation of the corresponding protocols (2004–1012 vs 2013–2016 for placenta accreta spectrum and 1988–2007 vs 2008–2016 for Vasa Previa). Clinical reports of women diagnosed with placenta accreta spectrum and Vasa Previa during the study periods were reviewed and outcomes were compared. Results In total, there were 97 cases of placenta accreta spectrum and 51 cases with Vasa Previa, all confirmed at delivery. In both cohorts, the prenatal detection rate increased after implementation of the scanning protocols (28 of 65 cases [43.1%] vs 31 of 32 cases [96.9%], P Conclusion The implementation of standardized prenatal targeted scanning protocols for pregnant women with risk factors for placenta accreta spectrum and Vasa Previa was associated with improved maternal and neonatal outcomes. The continuous increases in the rates of caesarean deliveries and use of assisted reproductive technology highlights the need to develop training programs and introduce targeted scanning protocols at the national and international levels.
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the rate of cervical length shortening in the management of Vasa Previa
Journal of Ultrasound in Medicine, 2018Co-Authors: Ron Maymon, Yaakov Melcer, Marina Pekarzlotin, Josef Tovbin, Noam Smorgick, Eric JauniauxAbstract:OBJECTIVES: There is no consensus about the optimal surveillance strategy in women with a diagnosis of Vasa Previa. The aim of this study was to evaluate the role of the rate of change in cervical length measurements in the management of singleton pregnancies with a diagnosis of Vasa Previa. METHODS: We performed a retrospective case‐control study of our databases for pregnancies with a prenatal diagnosis of Vasa Previa that were followed with transvaginal sonography for cervical length and evaluated the impact of the changes in cervical length on the need for emergency cesarean delivery. RESULTS: The cohort included 29 singleton pregnancies with a prenatal diagnosis of Vasa Previa in the second trimester. There were 14 and 15 pregnancies that underwent elective and emergency cesarean delivery, respectively. The rate of cervical length shortening was significantly slower for women with elective compared to emergency cesarean delivery (median [range], 0.7 [0.1–2.0] versus 1.5 [0.25–3.0] mm/wk; P = .011). For each additional millimeter‐per‐week decrease in cervical length, the odds of emergency cesarean delivery increased by 6.50 (95% confidence interval, 1.02–41.20). The receiver operating characteristic curve for the rate of cervical length shortening in the prediction of emergency cesarean delivery yielded an area under the curve of 0.85 (95% confidence interval, 0.69–0.99). CONCLUSIONS: Our findings indicate an association between the rate of cervical length shortening and the risk of emergency cesarean delivery in pregnancies with a diagnosis of Vasa Previa in the second trimester. Further multicentric studies are required to validate our data prospectively and, in particular, the role of serial cervical length measurements in determining the optimal delivery time for individual cases.
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evaluation of the impact of Vasa Previa on feto placental hormonal synthesis and fetal growth
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2017Co-Authors: Yaakov Melcer, Marina Pekarzlotin, Ron Maymon, Josef Tovbin, Orna Levinsohntavor, Eric JauniauxAbstract:Abstract Introduction A Vasa Previa (VP) refers to aberrant chorionic vessels which can either connect the chorionic plate to a velamentous cord (type I) or a succenturiate or accessory lobe to the main placental mass (type II). Methods We performed retrospective cohort study of 32 singleton pregnancies diagnosed with VP. The levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and unconjugated estriol (uE3) were measured at 15–18 weeks as part of the triple test screening for Trisomy 21. The data were subdivided according to the type of VP and compared with those of a control group with central cord insertion and no succenturiate or accessory placental lobe. Results Twenty one (65.6%) parturient women presented with VP type I and 11 (34.4%) with VP type II. The mean birthweight and placental weight was significantly higher in pregnancies with VP type II than in pregnancies with VP with VP type I (3037.3 ± 400.9 gr vs 2493.5 ± 491.6 gr; p = 0.004 and 511.0 ± 47.2 gr vs 367.1 ± 64.3 gr; p p Conclusions There is no obvious impact on both placental and fetal growth in VP type II. By contrast, VP type I is associated with slower feto-placental growth secondary to impaired development and biological functions of the placenta during the first half of pregnancy.
Ramen H Chmait - One of the best experts on this subject based on the ideXlab platform.
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fetoscopic laser ablation therapy for type ii Vasa Previa
Obstetrical & Gynecological Survey, 2021Co-Authors: Ramen H Chmait, Valerian Catanzarite, Andrew H Chon, Lisa M Korst, Arlyn Llanes, Joseph G OuzounianAbstract:Background In type II Vasa Previa, fetoscopic laser ablation has the potential to avoid prolonged hospitalization, elective prematurity, and cesarean delivery associated with traditional conservative management. Objective To assess the feasibility and to report perinatal outcomes of type II Vasa Previa patients treated via fetoscopic laser ablation. Study design This is a retrospective descriptive study of all women with Vasa Previa treated with laser at our center between 2006 and 2019. After 2010, laser ablation of Vasa Previa was only offered after 31 gestational weeks. Continuous variables are expressed as means ± SD. Results 33 patients were evaluated for laser ablation of suspected Vasa Previa. Fifteen were not candidates (7 had type I Vasa Previa and 8 had no Vasa Previa), and the 18 remaining had type II Vasa Previa. Ten (56%) elected to undergo in utero laser ablation of the Vasa Previa vessel(s), which was successful in all patients. The mean gestational age (GA) at the time of the procedure was 28.8 ± 5.4 weeks, and the total operative time was 48.1 ± 21.3 min; there were no perioperative complications. The number of vessels lasered were distributed as follows: 1 (2 cases), 2 (5 cases), and 3 (3 cases). All patients except for 1 were subsequently managed as outpatients. The mean GA at delivery was 35.5 ± 3.2 weeks, and vaginal delivery occurred in 5 cases. The 5 patients with singletons who underwent laser ablation for primary diagnosis of type II Vasa Previa after the protocol change in 2010 had the following outcomes: mean GA of surgery was 32.5 ± 0.8 weeks, mean GA at delivery was 38.1 ± 1.4 weeks, vaginal delivery occurred in all cases, mean birth weight was 2,965 ± 596 g, and none were admitted to the neonatal intensive care unit. Conclusion This cohort represents the largest number of Vasa Previa cases treated via in utero laser reported to date. Laser occlusion of type II Vasa Previa was technically achievable in all cases and resulted in favorable outcomes.
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term vaginal delivery following fetoscopic laser photocoagulation of type ii Vasa Previa
Fetal Diagnosis and Therapy, 2013Co-Authors: R Johnston, V K Shrivastava, Ramen H ChmaitAbstract:Unrecognized Vasa Previa carries a significant risk of fetal mortality. Advances in ultrasound have improved detection of Vasa Previa and led to a dramatic reduction in fetal morbidity and mortality. However, current management strategies require prolonged hospitalized surveillance, preterm delivery prior to the onset of labor or rupture of membranes, and a cesarean delivery. Fetoscopic laser ablation of type II Vasa Previa allows for the possibility of term vaginal delivery. We present a patient who underwent successful laser photocoagulation of a type II Vasa Previa at 32(5)/7 weeks' gestation. She subsequently delivered vaginally at term without complications. The potential benefits of definitive in utero treatment of non-type I Vasa Previa, such as vaginal delivery at term, must be weighed against the procedure-related risks of operative fetoscopy.
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third trimester fetoscopic laser ablation of type ii Vasa Previa
Journal of Maternal-fetal & Neonatal Medicine, 2009Co-Authors: Ramen H Chmait, Emiliano Chavira, Eftichia V Kontopoulos, R A QuinteroAbstract:Objective. Vasa Previa is associated with increased perinatal morbidity and mortality because of fetal exsanguination at time of membrane rupture. We report our experience in the treatment of type II Vasa Previa via in utero laser ablation in the third trimester.Methods. Two cases of type II Vasa Previa were identified via endovaginal ultrasound in the second trimester and treated via third trimester fetoscopic laser ablation.Results. In case 1, fetoscopic laser ablation of the Vasa Previa was performed without complication at 28 3/7 weeks' gestation as a prophylactic measure. The patient delivered at 33 3/7 weeks' gestation after rupture of membranes without sequelae with good perinatal outcome. In case 2, expectant management of twins with a Vasa Previa was planned. However, significant cervical shortening and funneling was documented at 30 5/7 weeks', and the risk of membrane rupture was deemed relatively high. As a therapeutic alternative to outright preterm delivery, the patient underwent uncomplicat...
Val Catanzarite - One of the best experts on this subject based on the ideXlab platform.
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prenatally diagnosed Vasa Previa a single institution series of 96 cases
Obstetrics & Gynecology, 2016Co-Authors: Val Catanzarite, Larry Cousins, Sean Daneshmand, Wade Schwendemann, Holly L Casele, Joanna Adamczak, Tevy Tith, Ami PatelAbstract:To describe outcomes for a large cohort of women with prenatally diagnosed Vasa Previa, determine the percentage in patients without risk factors, and compare delivery timing and indications for singletons and twins.This was a retrospective case series of women with prenatally diagnosed Vasa Previa delivered at a single tertiary center over 12 years. Potential participants were identified using hospital records and perinatal databases. Patients were included if Vasa Previa was confirmed at delivery and by pathologic examination. Maternal and newborn data were gathered from medical records.There were 77 singleton and 19 twin pregnancies with a prenatal diagnosis of Vasa Previa. There was one neonatal death from congenital heart disease. Perinatal management of recommended elective hospitalizations with corticosteroid administration and elective early delivery resulted in average gestational age for delivery in singletons at 34.7±1.6 weeks and 32.8±2.2 weeks for twins. Among the 77 singletons, delivery was elective in 48, as a result of contractions or labor in 21, bleeding in four, nonreassuring tracing in two, asymptomatic cervical shortening in one, and preeclampsia in one. Among 19 twins, delivery was elective in six and for contractions or labor in 13. Sixty-eight percent of twins compared with 37% of singletons had nonelective delivery (P<.05). Delivery occurred by 32 weeks of gestation in 6.4% of singletons and 26% of twins (P<.05) and by 34 weeks of gestation in 11% of singletons and 58% of twins (P<.001). Six neonates (5.2%) had major anomalies, all prenatally detected. Respiratory distress syndrome occurred in 57.1% of singletons and 65.7% of twins. Nineteen singletons (24.7%) had no risk factors for Vasa Previa.Planned preterm delivery for women with prenatally diagnosed Vasa Previa resulted in elective delivery for singletons in 62% and for twins 32%. Gestational age at birth on average was 34.7 weeks for singletons and 32.8 weeks of gestation for twins. Major anomalies were frequent as was respiratory distress syndrome. Elective delivery between 34 and 35 weeks of gestation for singletons is reasonable. As a result of the high rate of nonelective delivery in twins, delivery at 32-34 weeks of gestation may be risk-beneficial. The high rate of singletons without risk factors for Vasa Previa reinforces the recommendation to screen routinely for cord insertion site.
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Vasa Previa the impact of prenatal diagnosis on outcomes
Obstetrics & Gynecology, 2004Co-Authors: Yinka Oyelese, Susan Lashley, Val Catanzarite, F Prefumo, Morey Schachter, Yosi Tovbin, Victoria Goldstein, John C SmulianAbstract:OBJECTIVE:To evaluate outcomes and predictors of neonatal survival in pregnancies complicated by Vasa Previa and to compare outcomes in prenatally diagnosed cases of Vasa Previa with those not diagnosed prenatally.METHODS:We performed a multicenter study of 155 pregnancies complicated by Vasa Previa
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prenatal sonographic diagnosis of Vasa Previa ultrasound findings and obstetric outcome in ten cases
Obstetrical & Gynecological Survey, 2002Co-Authors: Val Catanzarite, C Maida, W Thomas, A Mendoza, L Stanco, K M PiacquadioAbstract:In Vasa Previa, a condition in which fetal vessels course within the membranes between the presenting part and the cervix and are unprotected by Wharton's jelly, there is danger that the vessels will be compressed during labor and tear when the membranes rupture. Fetal exsanguination is a possibility. Vasa Previa also can cause abnormal intrapartum fetal heart rate patterns. Ultrasonography now offers the possibility of identifying this anatomical variant well before the onset of labor. The authors report 11 cases of Vasa Previa, unaccompanied by placenta Previa, that were diagnosed prospectively by color Doppler sonography among 33,208 women during the years 1991-1998. Patients were offered elective operative delivery after fetal lung maturity was documented but before the onset of labor. Transabdominal sonography now includes a routine attempt to image the insertion of the cord into the placenta. A color Doppler or color power angio "sweep" is made across the lower uterine segment to find velamentous vessels overlying the cervix. The diagnosis of Vasa Previa was confirmed at delivery in 10 cases, and one woman was thought to have a marginal placenta Previa. Type I Vasa Previa, with a single placental lobe and a velamentous cord insertion, was diagnosed in two cases, and type II (vessels over the cervix connected between lobes of a multilobed placenta) in eight. With one exception, placenta Previa was described at initial sonography. All but 2 of the 10 patients with established Vasa Previa had vaginal bleeding in the third trimester, and five were admitted to the hospital. Two deliveries occurred before lung maturity was demonstrated, whereas the others took place at 34 to 37.5 weeks' gestation, after confirmed lung maturity. All the infants had normal Apgar scores and survived. The best screening approach for Vasa Previa may be to perform transvaginal sonography in the late first or early second trimester and targeted sonography when "resolving" placenta Previa or a low-lying bilobed placenta is suspected.
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prenatal sonographic diagnosis of Vasa Previa ultrasound findings and obstetric outcome in ten cases
Ultrasound in Obstetrics & Gynecology, 2001Co-Authors: Val Catanzarite, C Maida, W Thomas, A Mendoza, L Stanco, K M PiacquadioAbstract:Objective To assess the specificity of sonographic diagnosis of Vasa Previa and pregnancy outcome in sonographically diagnosed cases. Methods We prospectively collected cases of Vasa Previa diagnosed by color Doppler sonography. Delivery by elective Cesarean section after demonstration of fetal pulmonary maturity and prior to the onset of labor was recommended unless obstetric complications supervened. Data regarding maternal obstetric courses and newborn status were collected. Results Eleven cases of Vasa Previa without placenta Previa were diagnosed among 33 208 women over an 8-year period. Ten patients had confirmation of the diagnosis by the delivering obstetrician and/or placental examination, giving a specificity of diagnosis of 91%. Among the 10 patients with confirmed Vasa Previa, two were delivered at 31.5 and 35.5 weeks' gestation prior to demonstration of lung maturity, and the remainder were delivered at 34–37.5 weeks, after lung maturity. All infants had normal Apgar scores and survived. One baby had Scimitar syndrome, which was not suspected from sonography. Conclusions The specificity of sonographic diagnosis of Vasa Previa at our center was 91%. Antenatal diagnosis permitted us to prevent the catastrophic outcomes commonly associated with Vasa Previa. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
