The natural history and management of vasa previa: a single institution’s 15-year experience managing patients remote from labor and delivery

Abstract

Introduction: Vasa previa (VP) is a diagnosis with potential catastrophic obstetric outcomes. We describe the outcomes of VP managed at our institution, which uniquely provides inpatient monitoring on an antepartum unit located remotely from labor and delivery (L&D). Methods: Retrospective study of singleton pregnancies diagnosed with VP at a single institution. VP was diagnosed prenatally by ultrasound if one or more fetal vessels unsupported by underlying placenta were coursing within 2 cm of the internal os. Most cases were admitted for inpatient monitoring; however, patients were counseled that high-quality data were lacking demonstrating superiority of inpatient admission compared to outpatient management. Descriptive analyses were performed to compare outcomes in patients with resolved vs. persistent VP as well outpatient versus inpatient management among those with persistent VP. Results are reported as median (range). Results: Fifty patients were diagnosed with VP at a gestational age of 22.9 weeks (18.0–34.3) with 38 (76.0%) VP persisting until delivery. There was an outpatient group (8, 21.0%) who declined hospital monitoring, and an inpatient group (30, 79.0%). The admission GA for the inpatient group was 31.2 weeks (25.6–34.3) for a duration of 19.5 days (2–52). The majority (70%) of patients required at least one transfer from the antepartum unit to L&D. There was no difference in urgent or emergent cesarean deliveries among patients managed outpatient vs. inpatient [3 (37.5%) vs 13 (43.3%), p = 0.547]. There were no cases of neonatal anemia related to VP or perinatal deaths. Conclusion: Admitting patients with VP to a location separate from the L&D operating rooms was not associated with adverse pregnancy or neonatal outcomes. Monitoring of patients with vasa previa in a location remote from L&D was not associated with worse pregnancy outcomes.