Diagnosis and management of vasa previa: a questionnaire survey.
OBJECTIVE
Our aim was to assess the current use of obstetric ultrasound imaging for the diagnosis of asymptomatic vasa previa. We also investigated obstetricians' views on the feasibility of a screening policy and their awareness of risk factors associated with this condition.


METHODS
A national postal survey was conducted between March and July 2006. A total of 234 questionnaires were sent to obstetric and fetomaternal consultants across England and Wales. In all, 128 questionnaires were returned, a response rate of 55%.


RESULTS
Most respondents (85%) stated that in their hospital they do not report velamentous cord insertions at the anomaly scan. However, 73% occasionally or routinely document the presence of succenturiate lobes. Only 33% of respondents offered transvaginal scanning for the identification of vasa previa within their hospital, whereas only 6% had ever referred women to a tertiary center for this indication. In all, 34% of the respondents did not identify any risk factor for the condition. Most respondents (80%) would offer an elective Cesarean section if vasa previa was suspected antenatally; the majority would perform it at 38 weeks' gestation. However, only 20% of respondents felt that an effective screening policy is possible.


CONCLUSIONS
Despite evidence that perinatal death can be prevented by antenatal diagnosis of vasa previa, most obstetricians in England and Wales feel that a screening policy is not possible. The majority of them would offer an elective Cesarean section for vasa previa at around 38 weeks. There is a need to increase awareness and understanding of the major risk factors for this condition.
Ioannou
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Department of Obstetrics and Gynaecology, Wycombe General Hospital, High Wycombe, UK.
Wayne
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D004739:England / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D009774:Obstetrics / Q000706:statistics & numerical data*; D010922:Placenta Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal; D055949:Vasa Previa / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D014852:Wales / Q000453:epidemiology