Premium
OP14.04: Vasa previa: is there a role for cervical length measurement? Review of cases of antenatal management
Author(s) -
Romero V.,
Treadwell M. C.,
Nugent C.
Publication year - 2010
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.8052
Subject(s) - medicine , obstetrics
Objectives: The limited data regarding best management for patients with vasa previa provides a challenge. The current case review was undertaken to examine the role of serial cervical length evaluation in the surveillance of these patients. Methods: This was a retrospective study of cases of vasa previa diagnosed in our obstetric ultrasound database in the past 3 years. Data regarding diagnosis, antenatal course and obstetric outcomes was collected. Results: 13 cases were reported between 2007 and 2010. Antenatal information was available in 13 patients with outcome data for the 9 patients delivering at our institution. 5/13 (38.5%) were nulliparous. 9/13 (69.2%) cases were singleton gestations and 4/13 (30.8%) multiple pregnancies. None of the patients had a previous history of preterm birth. Median gestational age at diagnosis was 18 weeks (range 12–31 weeks). 7/13 (53.8%) of the patients were diagnosed at the first US examination. Serial monitoring of cervical length was performed in the 9 cases followed at our center at variable intervals. One patient with an initial cervical length > 25 mm subsequently had a short cervix at 20 wks (17 mm). She underwent cerclage placement, then presented in preterm labor and delivered by Cesarean section at 24 weeks. Other patient admitted at 33 weeks for cervical shortening, delivered 2 days later. 3/9 (33.3%) of patients were delivered at 34 wks and 3/9 (33.3%) at 35 wks by elective Cesarean section. Bethametasone for fetal lung maturity was given in 7/9 (77.8%) of the cases. Conclusions: Vasa previa was not always recognized at the time of the first ultrasound, but diagnosis occurred in patients undergoing follow up examinations in 46% of cases. Serial measurements of the cervical length in vasa previa patients may help to identify those at risk of preterm birth that would benefit from inpatient care or earlier delivery. Further studies are needed to assess the optimal role of serial assessment of cervical length in antenatal management.