Denver Health Medical Center and the University of Colorado School of Medicine, Aurora, Colorado.
Obstet Gynecol. 2023 Sep 1;142(3):519-528. doi: 10.1097/AOG.0000000000005296.
To determine the causes and potential preventability of perinatal deaths in prenatally identified cases of vasa previa.
Reports of prenatally identified cases of vasa previa published in the English language literature since 2000 were identified in Medline and ClinicalTrials.gov with the search terms "vasa previa," "abnormal cord insertion," "velamentous cord," "marginal cord," "bilobed placenta," and "succenturiate lobe."
All cases from the above search with an antenatally diagnosed vasa previa present at delivery in singleton or twin gestations with perinatal mortality information were included.
TABULATION, INTEGRATION, AND RESULTS: Cases meeting inclusion criteria were manually abstracted, and multiple antenatal, intrapartum, and outcome variables were recorded. Deaths and cases requiring neonatal transfusion were analyzed in relation to plurality, routine hospitalization, and cervical length monitoring. A total of 1,109 prenatally diagnosed cases (1,000 singletons, 109 twins) were identified with a perinatal mortality rate attributable to vasa previa of 1.1% (95% CI 0.6-1.9%). All perinatal deaths occurred with unscheduled deliveries. The perinatal mortality rate in twin pregnancies was markedly higher than that in singleton pregnancies (9.2% vs 0.2%, P <.001), accounting for 80% of overall mortality despite encompassing only 9.8% of births. Compared with individuals with singleton pregnancies, those with twin pregnancies are more likely to undergo unscheduled delivery (56.4% vs 35.1%, P =.01) despite delivering 2 weeks earlier (33.2 weeks vs 35.1 weeks, P =.006). An institutional policy of routine hospitalization is associated with a reduced need for neonatal transfusion (0.9% vs 6.0%, P <.001) and a reduction in the perinatal mortality rate in twin pregnancies (0% vs 25%, P =.002) but not in singleton pregnancies (0% vs 0.5%, P =.31).
Routine hospitalization and earlier delivery of twins may result in a reduction in the perinatal mortality rate. A smaller benefit from routine admission of individuals with singleton pregnancies cannot be excluded. There is currently insufficient evidence to recommend the routine use of cervical length measurements to guide clinical management.
确定产前诊断帆状胎盘病例围产儿死亡的原因和潜在可预防因素。
在 Medline 和 ClinicalTrials.gov 中使用“帆状胎盘”、“脐带异常插入”、“帆状脐带”、“边缘脐带”、“双叶胎盘”和“副叶”等术语，检索了 2000 年以来发表的英文文献中关于产前诊断帆状胎盘病例的报道。
纳入所有上述检索中符合条件的病例，这些病例均为单胎或双胎妊娠，分娩时存在产前诊断的帆状胎盘，并伴有围产儿死亡信息。
列表、整合和结果：手工摘录符合纳入标准的病例，并记录多个产前、产时和结局变量。分析了多发性、常规住院和宫颈长度监测与新生儿输血需求的关系。共确定了 1109 例产前诊断的帆状胎盘病例（1000 例单胎，109 例双胎），围产儿死亡率归因于帆状胎盘的为 1.1%（95%CI 0.6-1.9%）。所有围产儿死亡均发生在非计划性分娩中。双胎妊娠的围产儿死亡率明显高于单胎妊娠（9.2%比 0.2%，P<.001），尽管仅占分娩的 9.8%，但占总死亡率的 80%。与单胎妊娠者相比，双胎妊娠者更有可能发生非计划性分娩（56.4%比 35.1%，P=.01），尽管其分娩时间提前了 2 周（33.2 周比 35.1 周，P=.006）。常规住院的机构政策与新生儿输血需求减少（0.9%比 6.0%，P<.001）和双胎妊娠围产儿死亡率降低（0%比 25%，P=.002）相关，但与单胎妊娠无关（0%比 0.5%，P=.31）。
常规住院和双胎妊娠的提前分娩可能会降低围产儿死亡率。不能排除常规住院对单胎妊娠者的益处较小。目前尚无足够证据推荐常规使用宫颈长度测量来指导临床管理。
