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Vasa Previa Diagnosis, Clinical Practice, and Outcomes in Australia

Sullivan, Elizabeth A. MD, FAFPHM; Javid, Nasrin RM, MMedSci; Duncombe, Gregory MBBS, FRANZCOG; Li, Zhuoyang BMed, MPH; Safi, Nadom MBChB, MPH; Cincotta, Robert MBBS, FRANZCOG; Homer, Caroline S. E. RM, PhD; Halliday, Lesley BSc, PhD; Oyelese, Yinka MD, MRCOG

doi: 10.1097/AOG.0000000000002198
Contents: Original Research

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 between May 1, 2013, and April 30, 2014, in hospitals in Australia with greater than 50 births per year. Women were included if they were diagnosed with vasa previa during pregnancy or childbirth, confirmed by clinical examination or placental pathology. The main outcome measures included stillbirth, neonatal death, cesarean delivery, and preterm birth.

RESULTS: Sixty-three women had a confirmed diagnosis of vasa previa. The estimated incidence was 2.1 per 10,000 women giving birth (95% CI 1.7–2.7). Fifty-eight women were diagnosed prenatally and all had a cesarean delivery. Fifty-five (95%) of the 58 women had at least one risk factor for vasa previa with velamentous cord insertion (62%) and low-lying placenta (60%) the most prevalent. There were no perinatal deaths in women diagnosed prenatally. For the five women with vasa previa not diagnosed prenatally, there were two perinatal deaths with a case fatality rate of 40%. One woman had an antepartum stillbirth and delivered vaginally and the other four women had cesarean deliveries categorized as urgent threat to the life of a fetus with one neonatal death. The overall perinatal case fatality rate was 3.1% (95% CI 0.8–10.5). Two thirds (68%) of the 65 neonates were preterm and 29% were low birth weight.

CONCLUSION: The outcomes for neonates in which vasa previa was not diagnosed prenatally were inferior with higher rates of perinatal morbidity and mortality. Our study shows a high rate of prenatal diagnosis of vasa previa in Australia and associated good outcomes.

Prenatal diagnosis of vasa previa is a critical determinant of optimal outcomes for mothers and their neonates in Australia.

Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, the Department of Obstetrics and Gynaecology, School of Medicine, and the Centre for Clinical Research, University of Queensland, and the Department of Maternal-Fetal Medicine, Mater Mothers’ Hospital, South Brisbane, Queensland, and the School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia; and Atlantic Health System, Morristown, New Jersey.

Corresponding author: Elizabeth A. Sullivan, MD, FAFPHM, Faculty of Health, University of Technology Sydney, Australia, PO Box 123, Broadway, New South Wales 2007, Australia; email: Elizabeth.Sullivan@uts.edu.au.

The International Vasa Previa Foundation (Ref: RG123304) provided funding for Vasa Previa in Australia: Surveillance, Management, Outcomes and Experiences.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the Royal College of Obstetricians and Gynaecologists World Congress 2015, April 12–15, 2015, Brisbane, Australia.

The authors thank the participating maternity units and Australasian Maternity Outcomes Surveillance System (AMOSS) data collectors in Australia who participated in the study as well as the AMOSS Associate Investigators and AMOSS Advisory Group.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.