Perinatal outcome of pregnancies with prenatal diagnosis of vasa previa: systematic review and meta‐analysis
Journal article
Zhang, W., Geris, S., Al‐Emara, N., Ramadan, G., Sotiriadis, A. and Akolekar, R. 2021. Perinatal outcome of pregnancies with prenatal diagnosis of vasa previa: systematic review and meta‐analysis. Ultrasound in Obstetrics & Gynecology. 57 (5), pp. 710-719. https://doi.org/10.1002/uog.22166
Authors | Zhang, W., Geris, S., Al‐Emara, N., Ramadan, G., Sotiriadis, A. and Akolekar, R. |
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Abstract | ABSTRACTObjectivesTo derive accurate estimates of perinatal survival in pregnancies with and without a prenatal diagnosis of vasa previa based on a systematic review of the literature and meta‐analysis.MethodsA search of MEDLINE, EMBASE and The Cochrane Library was performed to review relevant citations reporting on the perinatal outcomes of pregnancies with vasa previa. We included prospective and retrospective cohort and population studies that provided data on pregnancies with a prenatal diagnosis of vasa previa or cases diagnosed at birth or following postnatal placental examination. Meta‐analysis using a random‐effects model was performed to derive weighted pooled estimates of perinatal survival (excluding stillbirths and neonatal deaths) and intact perinatal survival (additionally excluding hypoxic morbidity). Incidence rate difference (IRD) meta‐analysis was used to estimate the significance of differences in pooled proportions between cases of vasa previa with and those without a prenatal diagnosis. Heterogeneity between studies was estimated using Cochran's Q and the I2 statistic.ResultsWe included 21 studies reporting on the perinatal outcomes of 683 pregnancies with a prenatal diagnosis of vasa previa. There were three stillbirths (1.01% (95% CI, 0.40–1.87%)), five neonatal deaths (1.19% (95% CI, 0.52–2.12%)) and 675 surviving neonates, resulting in a pooled estimate for perinatal survival of 98.6% (95% CI, 97.6–99.3%). Based on seven studies that included cases of vasa previa with and without a prenatal diagnosis, the pooled perinatal survival in pregnancies without a prenatal diagnosis (61/118) was 72.1% (95% CI, 50.6–89.4%) vs 98.6% (95% CI, 96.7–99.7%) in cases with a prenatal diagnosis (224/226). Therefore, the risk of perinatal death was 25‐fold higher when a diagnosis of vasa previa was not made antenatally, compared with when it was (odds ratio (OR), 25.39 (95% CI, 7.93–81.31); P < 0.0001). Similarly, the risk of hypoxic morbidity was increased 50‐fold in cases with vasa previa without a prenatal diagnosis compared with those with a prenatal diagnosis (36/61 vs 5/224; OR, 50.09 (95% CI, 17.33–144.79)). The intact perinatal survival rate in cases of vasa previa without a prenatal diagnosis was significantly lower than in those with a prenatal diagnosis (28.1% (95% CI, 14.1–44.7%) vs 96.7% (95% CI, 93.6–98.8%)) (IRD, 73.4% (95% CI, 53.9–92.7%); Z = –7.4066, P < 0.001).ConclusionsPrenatal diagnosis of vasa previa is associated with a high rate of perinatal survival, whereas lack of an antenatal diagnosis significantly increases the risk of perinatal death and hypoxic morbidity. Further research should be undertaken to investigate strategies for incorporating prenatal screening for vasa previa into routine clinical practice. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. |
Keywords | Obstetrics and Gynecology; Radiology, Nuclear Medicine and imaging; Reproductive Medicine; General Medicine; Radiological and Ultrasound Technology |
Year | 2021 |
Journal | Ultrasound in Obstetrics & Gynecology |
Journal citation | 57 (5), pp. 710-719 |
Publisher | Wiley |
ISSN | 0960-7692 |
1469-0705 | |
Digital Object Identifier (DOI) | https://doi.org/10.1002/uog.22166 |
Official URL | https://doi.org/10.1002/uog.22166 |
Publication dates | |
Online | 03 May 2021 |
Publication process dates | |
Deposited | 26 May 2021 |
Accepted | 17 Jul 2020 |
Publisher's version | File Access Level Open |
Output status | Published |
Additional information | Publications router: Date 2020-07-17 of type 'accepted_date' included in notification. |
Publications router: License for VOR version of this article starting on 2021-05-03: http://creativecommons.org/licenses/by-nc-nd/4.0/ included in notification | |
License | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
https://repository.canterbury.ac.uk/item/8xwy6/perinatal-outcome-of-pregnancies-with-prenatal-diagnosis-of-vasa-previa-systematic-review-and-meta-analysis
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