title: Natural history of vasa previa across gestation using a screening protocol.
abstract: OBJECTIVE
  The purpose of this study was to estimate the prevalence and persistence rate of vasa previa in at-risk pregnancies using a standardized screening protocol.
  
  
  METHODS
  We conducted a descriptive study of patients with a diagnosis of vasa previa from a single ultrasound unit between June 2005 and June 2012. Vasa previa was defined as a fetal vessel within 2 cm of the internal cervical os on transvaginal sonography. Screening for vasa previa using transvaginal sonography with color flow mapping was performed routinely in the following situations: resolved placenta previa, prior pregnancy with vasa previa, velamentous insertion of the cord in the lower uterine segment, placenta succenturiata in the lower uterine segment, and twin gestations.
  
  
  RESULTS
  A total of 27,573 patients were referred to our unit for fetal anatomic surveys over the study period. Thirty-one cases of vasa previa were identified, for an incidence of 1.1 per 1000 pregnancies. Twenty-nine cases had full records available for analysis. Five patients (17.2%) had migration and resolution of the vasa previa. When the diagnosis was made during the second trimester (<26 weeks), there was a 23.8% resolution rate (5 of 21); when the diagnosis was made in the third trimester, none resolved (0 of 8 cases). Of the 24 pregnancies (5 twin gestations and 19 singleton gestations) with persistent vasa previa, there was 100% perinatal survival and a median length of gestation of 35 weeks (range, 27 weeks 5 days-36 weeks 5 days). No known missed cases were identified over the study period.
  
  
  CONCLUSIONS
  The use of standardized screening for vasa previa based on focused criteria was found to be effective in diagnosing vasa previa, with a 100% survival rate. Vasa previa diagnosed during the second trimester resolves in approximately 25% of cases.
authors.affiliation: Maternal-Fetal Medicine Associates, PLLC, 70 East 90th St, New York, NY 10128 USA. arebarber@mfmnyc.com.
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
authors.forename: Cara
authors.initials: C
authors.lastname: Dolin
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Fox
authors.forename: Chad K
authors.initials: CK
authors.lastname: Klauser
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Saltzman
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Roman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000706:statistics & numerical data*; D055949:Vasa Previa / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: obstetric ultrasound; prenatal diagnosis; vasa previa migration; vasa previa screening