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The potential impact of universal screening for vasa previa in the prevention of stillbirths

  • Weiyu Zhang , Yinka Oyelese ORCID logo EMAIL logo , Ali Javinani ORCID logo , Alireza Shamshirsaz and Ranjit Akolekar
Published/Copyright: September 9, 2024
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 52 Issue 9

Abstract

Objectives

To estimate the number of pregnancies complicated by vasa previa annually in nine developed countries, and the potential preventable stillbirths associated with undiagnosed cases. We also assessed the potential impact of universal screening for vasa previa on reducing stillbirth rates.

Methods

We utilized nationally-reported birth and stillbirth data from public databases in the United States, United Kingdom, Canada, Germany, Ireland, Greece, Sweden, Portugal, and Australia. Using the annual number of births and the number and rate of stillbirths in each country, and the published incidence of vasa previa and stillbirth rates associated with the condition, we estimated the expected annual number of cases of vasa previa, those that would result in a livebirth, and the potential preventable stillbirths with and without prenatal diagnosis.

Results

There were 6,099,118 total annual births with 32,550 stillbirths, corresponding to a summary stillbirth rate of 5.34 per 1,000 pregnancies. The total expected vasa previa cases was estimated to be 5,007 (95 % CI: 3,208–7,201). The estimated number of livebirths would be 4,937 (95 % CI: 3,163–7,100) and 3,610 (95 % CI: 2,313–5,192) in pregnancies with and without a prenatal diagnosis of VP. This implies that prenatal diagnosis would potentially prevent 1,327 (95 % CI: 850–1,908) stillbirths in these countries, corresponding to a potential reduction in stillbirth rate by 4.72 % (95 % CI: 3.80–5.74) if routine screening for vasa previa was performed.

Conclusions

Our study highlights the importance of universal screening for vasa previa and suggests that prenatal diagnosis of prevention could potentially reduce 4–5 % of stillbirths.

Keywords: vasa previa; ultrasound; prenatal diagnosis; screening; stillbirth prevention; Doppler
Corresponding author: Yinka Oyelese, MD, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, KS3, Boston 02215, MA, USA; and Fetal Care and Surgery Center (FCSC), Division of Fetal Medicine and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA, E-mail:
Weiyu Zhang and Yinka Oyelese share first authorship. Yinka Oyelese and Ranjit Akolekar share senior authorship.

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: All the authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: Dr. Oyelese has received royalties for authorship from UpToDate and BMJ Best Practice. In addition, Dr. Oyelese is on the Scientific Advisory Board for Sonio LLC, for which he receives honoraria. The remaining authors report no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: Not applicable.

References

1. Jauniaux, E, Alfirevic, Z, Bhide, AG, Burton, G, Collins, S, Silver, R. Vasa praevia: diagnosis and management: green-top guideline No. 27b. BJOG 2019;126:e49–61. https://doi.org/10.1111/1471-0528.15307.Search in Google Scholar PubMed

2. Oyelese, Y, Javinani, A, Shamshirsaz, AA. Vasa previa. Obstet Gynecol 2023;142:503–18. https://doi.org/10.1097/aog.0000000000005287.Search in Google Scholar PubMed PubMed Central

3. Society of Maternal-Fetal Publications Committee; Sinkey, RG, Odibo, AO, Dashe, JS. #37: diagnosis and management of vasa previa. Am J Obstet Gynecol 2015;213:615–9. https://doi.org/10.1016/j.ajog.2015.08.031.Search in Google Scholar PubMed

4. Oyelese, KO, Turner, M, Lees, C, Campbell, S. Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv 1999;54:138–45. https://doi.org/10.1097/00006254-199902000-00024.Search in Google Scholar PubMed

5. Daly-Jones, EJA, Leahy, A, McKenna, C, Sepulveda, W. Vasa praevia; a preventable tragedy. Ultrasound 2008;16:8–14. https://doi.org/10.1179/174313408x259508.Search in Google Scholar

6. Zhang, W, Geris, S, Beta, J, Ramadan, G, Nicolaides, KH, Akolekar, R. Prevention of stillbirth: impact of two-stage screening for vasa previa. Ultrasound Obstet Gynecol 2020;55:605–12. https://doi.org/10.1002/uog.21953.Search in Google Scholar PubMed

7. Oyelese, Y, Catanzarite, V, Prefumo, F, Lashley, S, Schachter, M, Tovbin, Y, et al.. Vasa previa: the impact of prenatal diagnosis on outcomes. Obstet Gynecol 2004;103:937–42. https://doi.org/10.1097/01.aog.0000123245.48645.98.Search in Google Scholar PubMed

8. Bronsteen, R, Whitten, A, Balasubramanian, M, Lee, W, Lorenz, R, Redman, M, et al.. Vasa previa: clinical presentations, outcomes, and implications for management. Obstet Gynecol 2013;122:352–7. https://doi.org/10.1097/aog.0b013e31829cac58.Search in Google Scholar PubMed

9. Klahr, R, Fox, NS, Zafman, K, Hill, MB, Connolly, CT, Rebarber, A. Frequency of spontaneous resolution of vasa previa with advancing gestational age. Am J Obstet Gynecol 2019;221:646.e1–7. https://doi.org/10.1016/j.ajog.2019.06.040.Search in Google Scholar PubMed

10. Green, A, Chiu, S, Manor, E, Smith, L, Oyelese, Y. The association of gestational age at delivery with neonatal outcomes in prenatally diagnosed vasa previa. J Matern Fetal Neonatal Med 2022;35:10162–7. https://doi.org/10.1080/14767058.2022.2122040.Search in Google Scholar PubMed

11. Smorgick, N, Tovbin, Y, Ushakov, F, Vaknin, Z, Barzilay, B, Herman, A, et al.. Is neonatal risk from vasa previa preventable? The 20-year experience from a single medical center. J Clin Ultrasound 2010;38:118–22. https://doi.org/10.1002/jcu.20665.Search in Google Scholar PubMed

12. Catanzarite, V, Cousins, L, Daneshmand, S, Schwendemann, W, Casele, H, Adamczak, J, et al.. Prenatally diagnosed vasa previa: a single-institution series of 96 cases. Obstet Gynecol 2016;128:1153–61. https://doi.org/10.1097/aog.0000000000001680.Search in Google Scholar

13. Nwandison, M, Daly-Jones, E, Drought, A, Story, L, De-Rosnay, P, Sebire, N, et al.. Incorporation of vasa previa screening into a routine anomaly scan: a single center cohort study. Acta Obstet Gynecol Scand 2024;103:1466–73. https://doi.org/10.1111/aogs.14839.Search in Google Scholar PubMed PubMed Central

14. Gross, A, Markota, AB, Specht, C, Scheier, M. Systematic screening for vasa previa at the 20-week anomaly scan. Acta Obstet Gynecol Scand 2021;100:1694–9. https://doi.org/10.1111/aogs.14205.Search in Google Scholar PubMed

15. Kanda, E, Matsuda, Y, Kamitomo, M, Maeda, T, Mihara, K, Hatae, M. Prenatal diagnosis and management of vasa previa: a 6-year review. J Obstet Gynaecol Res 2011;37:1391–6. https://doi.org/10.1111/j.1447-0756.2011.01544.x.Search in Google Scholar PubMed

16. Swank, ML, Garite, TJ, Maurel, K, Das, A, Perlow, JH, Combs, CA, et al.. Vasa previa: diagnosis and management. Am J Obstet Gynecol 2016;215:223.e1–6. https://doi.org/10.1016/j.ajog.2016.02.044.Search in Google Scholar PubMed

17. Erfani, H, Haeri, S, Shainker, SA, Saad, AF, Ruano, R, Dunn, TN, et al.. Vasa previa: a multicenter retrospective cohort study. Am J Obstet Gynecol 2019;221:644.e1–5. https://doi.org/10.1016/j.ajog.2019.06.006.Search in Google Scholar PubMed

18. Westcott, JM, Simpson, S, Chasen, S, Vieira, L, Stone, J, Doulaveris, G, et al.. Prenatally diagnosed vasa previa: association with adverse obstetrical and neonatal outcomes. Am J Obstet Gynecol MFM 2020;2:100206. https://doi.org/10.1016/j.ajogmf.2020.100206.Search in Google Scholar PubMed

19. Zhang, W, Geris, S, Al-Emara, N, Ramadan, G, Sotiriadis, A, Akolekar, R. Perinatal outcome of pregnancies with prenatal diagnosis of vasa previa: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021;57:710–19. https://doi.org/10.1002/uog.22166.Search in Google Scholar PubMed

20. Jauniaux, E, Savvidou, MD. Vasa praevia: more than 100 years in preventing unnecessary fetal deaths. BJOG 2016;123:1287. https://doi.org/10.1111/1471-0528.13869.Search in Google Scholar PubMed

21. United Kingdom National Screening Committee. Antenatal screening programme. Vasa praevia; 2023. Available from: https://view-health-screening-recommendations.service.gov.uk/vasa-praevia/.Search in Google Scholar

22. Hamilton Be, MJ, Osterman, MJK. Births: provisional data for 2022. Centre for Disease Control and Prevention. Vital Statistics Rapid Release; no 28; 2023. Available from: https://www.cdc.gov/nchs/data/vsrr/vsrr028.pdf.10.15620/cdc:127052Search in Google Scholar

23. Office for National Statistics. Births and deaths in England and Wales in 2022. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/bulletins/birthsummarytablesenglandandwales/2022#live-births.Search in Google Scholar

24. Statistics Sweden. Populations statistics. Official Statistics of Sweden. Available from: https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-composition/population-statistics/.Search in Google Scholar

25. Instituto Nacional de Estatistica. Statistics Portugal. Live births (No.) by place of residence of mother, sex, age of mother and order of birth (total of births). Annual. Available from: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_pesquisa&frm_accao=PESQUISAR&frm_show_page_num=1&frm_modo_pesquisa=PESQUISA_SIMPLES&frm_modo_texto=MODO_TEXTO_ALL&frm_texto=births&frm_imgPesquisar=.Search in Google Scholar

26. An Phriomh-Oifig. Central Statistics Office. Vital statistics annual report 2021. Infant mortality, stillbirths and maternal mortality 2021. Available from: https://www.cso.ie/en/releasesandpublications/ep/p-vsar/vitalstatisticsannualreport2021/infantmortalitystillbirthsandmaternalmortality2021/ [Accessed 5 May 2024].Search in Google Scholar

27. Northern Ireland Research and Statistics Agency. Registrar general annual report 2022. Births. Available from: https://www.nisra.gov.uk/publications/registrar-general-annual-report-2022-births.Search in Google Scholar

28. Hellenic Statistical Authority. Data on vital statistics: 2022; 2023. Available from: https://www.statistics.gr/en/statistics/-/publication/SPO03/-.Search in Google Scholar

29. Australian Institute of Health and Welfare. Australia’s mothers and babies: stillbirths and neonatal death. Available from: https://www.aihw.gov.au/reports/mothers-babies/stillbirths-and-neonatal-deaths.Search in Google Scholar

30. Bundesamt, S. German Federal Statistical Office. Births. Available from: https://www.destatis.de/EN/Themes/Society-Environment/Population/Births/Tables/birth-deaths.html.Search in Google Scholar

31. National Records of Scotland. Births. Available from: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/vital-events-reference-tables/2022/list-of-data-tables#section3.Search in Google Scholar

32. Statistics Canada. Live births and fetal deaths (stillbirths), by type of birth (single or multiple). Available from: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310042801.Search in Google Scholar

33. Gregory, ECWVC, Martin, JA. Fetal mortality in the United States: final 2020–2021 and 2021 – provisional 2022. Vital statistics Rapid Release; no 32. National Center for Health Statistics; 2023. Available from: https://www.cdc.gov/nchs/data/vsrr/vsrr032.pdf.10.15620/cdc:133319Search in Google Scholar

34. Zhang, W, Giacchino, T, Chanyarungrojn, PA, Ionescu, O, Akolekar, R. Incidence of vasa praevia: a systematic review and meta-analysis. BMJ Open 2023;13:e075245. https://doi.org/10.1136/bmjopen-2023-075245.Search in Google Scholar PubMed PubMed Central

35. Oyelese, Y, Lees, CC, Jauniaux, E. The case for screening for vasa previa: time to implement a life-saving strategy. Ultrasound Obstet Gynecol 2023;61:7–11. https://doi.org/10.1002/uog.26085.Search in Google Scholar PubMed

36. Saving Babies Lives – a care bundle for reducing perinatal mortality. Version 3.1; 2023. NHS England. Publication reference: PRN 00614. Available from: https://www.england.nhs.uk/publication/saving-babies-lives-version-three/.Search in Google Scholar

37. Ranzini, AC, Oyelese, Y. How to screen for vasa previa. Ultrasound Obstet Gynecol 2021;57:720–5. https://doi.org/10.1002/uog.23520.Search in Google Scholar PubMed

38. Nomiyama, M, Toyota, Y, Kawano, H. Antenatal diagnosis of velamentous umbilical cord insertion and vasa previa with color Doppler imaging. Ultrasound Obstet Gynecol 1998;12:426–9. https://doi.org/10.1046/j.1469-0705.1998.12060426.x.Search in Google Scholar PubMed

39. Sepulveda, W, Rojas, I, Robert, JA, Schnapp, C, Alcalde, JL. Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study. Ultrasound Obstet Gynecol 2003;21:564–9. https://doi.org/10.1002/uog.132.Search in Google Scholar PubMed

40. Ruiter, L, Kok, N, Limpens, J, Derks, JB, de Graaf, IM, Mol, BWJ, et al.. Systematic review of accuracy of ultrasound in the diagnosis of vasa previa. Ultrasound Obstet Gynecol 2015;45:516–22. https://doi.org/10.1002/uog.14752.Search in Google Scholar PubMed

41. Peake, JN, Knowles, RL, Shawe, J, Rankin, J, Copp, AJ. Maternal ethnicity and the prevalence of British pregnancies affected by neural tube defects. Birth Defects Res 2021;113:968–80. https://doi.org/10.1002/bdr2.1893.Search in Google Scholar PubMed PubMed Central

42. Nembhard, WN, Bergman, JEH, Politis, MD, Arteaga‐Vázquez, J, Bermejo-Sánchez, E, Canfield, MA, et al.. A multi-country study of prevalence and early childhood mortality among children with omphalocele. Birth Defects Res 2020;112:1787–801. https://doi.org/10.1002/bdr2.1822.Search in Google Scholar PubMed PubMed Central

43. Oyelese, Y, Javinani, A, Gudanowski, B, Krispin, E, Rebarber, A, Akolekar, R, et al.. Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus. Am J Obstet Gynecol 2024;15:S0002-9378(24)00442-3.Search in Google Scholar

44. Reddy, UM, Abuhamad, AZ, Levine, D, Saade, GR. Fetal Imaging Workshop Invited P. Fetal imaging: executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014;210:387–97. https://doi.org/10.1016/j.ajog.2014.02.028.Search in Google Scholar PubMed

45. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Vasa praevia; 2019. Available from: https://ranzcog.edu.au/wp-content/uploads/2022/05/Vasa-Praevia.pdf.Search in Google Scholar

46. Srinivasan, D, Daly-Jones, E, Oyelese, Y, Papanikolaou, K, Lees, CC. Challenging common misconceptions in vasa previa screening and diagnosis. Ultrasound Obstet Gynecol 2023. https://doi.org/10.1002/uog.27567 [Epub ahead of print].Search in Google Scholar PubMed

Received: 2024-05-05
Accepted: 2024-08-14
Published Online: 2024-09-09
Published in Print: 2024-11-26

© 2024 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. The utilization of artificial intelligence in enhancing 3D/4D ultrasound analysis of fetal facial profiles
  4. Commentary
  5. Respect for history: an important dimension of contemporary obstetrics and gynecology
  6. Opinion Papers
  7. Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa
  8. Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding – clinical implications and perspectives
  9. Original Articles – Obstetrics
  10. The potential impact of universal screening for vasa previa in the prevention of stillbirths
  11. Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter
  12. Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy
  13. Prediction of intrapartum caesarean section in vaginal breech birth: development of models for nulliparous and multiparous women
  14. Complementary and Alternative Medicine use among pregnant women attending antenatal clinic: a point to ponder
  15. Molecular evidence that GBS early neonatal sepsis results from ascending infection: comparative hybrid genomics analyses show that microorganisms in the vaginal ecosystem, amniotic fluid, chorioamniotic membranes, and neonatal blood are the same
  16. Original Articles – Fetus
  17. Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn
  18. New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus
  19. Original Articles – Neonates
  20. Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age
  21. Assessment of the validity and reliability of edinburgh postpartum depression scale in Turkish men
  22. Letter to the Editor
  23. Frequency and persistence of wide pulse pressure in the newborn population
https://doi.org/10.1515/jpm-2024-0203
Keywords for this article
vasa previa; ultrasound; prenatal diagnosis; screening; stillbirth prevention; Doppler

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. The utilization of artificial intelligence in enhancing 3D/4D ultrasound analysis of fetal facial profiles
  4. Commentary
  5. Respect for history: an important dimension of contemporary obstetrics and gynecology
  6. Opinion Papers
  7. Fetoscopic laser photocoagulation: a medically reasonable treatment option in the management of types II and III vasa previa
  8. Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding – clinical implications and perspectives
  9. Original Articles – Obstetrics
  10. The potential impact of universal screening for vasa previa in the prevention of stillbirths
  11. Preinduction cervical ripening in an outpatient setting: a prospective pilot study of a synthetic osmotic dilator compared with a double-balloon catheter
  12. Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy
  13. Prediction of intrapartum caesarean section in vaginal breech birth: development of models for nulliparous and multiparous women
  14. Complementary and Alternative Medicine use among pregnant women attending antenatal clinic: a point to ponder
  15. Molecular evidence that GBS early neonatal sepsis results from ascending infection: comparative hybrid genomics analyses show that microorganisms in the vaginal ecosystem, amniotic fluid, chorioamniotic membranes, and neonatal blood are the same
  16. Original Articles – Fetus
  17. Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn
  18. New measurement indicator of ultrasound assessment of the fetal pancreas based on anatomical landmarks and its application to fetuses with gestational diabetes mellitus
  19. Original Articles – Neonates
  20. Mode of delivery and behavioral and neuropsychological outcomes in children at 10 years of age
  21. Assessment of the validity and reliability of edinburgh postpartum depression scale in Turkish men
  22. Letter to the Editor
  23. Frequency and persistence of wide pulse pressure in the newborn population
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