Vasa previa: The impact of prenatal diagnosis on outcomes

被引:208
作者
Oyelese, Y
Catanzarite, V
Prefumo, F
Lashley, S
Schachter, M
Tovbin, Y
Goldstein, V
Smulian, JC
机构
[1] UMDNJ, Robert Wood Johnson Med Sch, Div Maternal Fetal Med, Dept Obstet Gynecol & Reprod Sci,Robert Wood John, New Brunswick, NJ USA
[2] Georgetown Univ Hosp, Dept Obstet & Gynecol, Washington, DC 20007 USA
[3] Sharp Perinatal Ctr, San Diego, CA USA
[4] Sharp Mary Birch Hosp, San Diego, CA USA
[5] Univ London St Georges Hosp, Sch Med, Fetal Med Unit, Dept Obstet & Gynaecol, London SW17 0RE, England
[6] Tel Aviv Univ, Dept Obstet & Gynecol, Assaf Harofeh Med Ctr, IL-69978 Tel Aviv, Israel
[7] Vasa Previa Fdn, Moline, IL USA
关键词
D O I
10.1097/01.AOG.0000123245.48645.98
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: To evaluate outcomes and predictors of neonatal survival in pregnancies complicated by vasa previa and to compare outcomes in prenatally diagnosed cases of vasa previa with those not diagnosed prenatally. METHODS: We performed a multicenter study of 155 pregnancies complicated by vasa previa. Cases were obtained from the Vasa Previa Foundation and 6 large hospitals. Comparisons were made between groups based on prenatal diagnosis status and neonatal survival. RESULTS: The overall perinatal mortality was 36% (55 of 155). In 61 cases (39%), vasa previa was diagnosed prenatally; 59 of 61 (97%) infants from these pregnancies survived compared with 41 of 94 (44%) in cases not diagnosed prenatally (P < .001). Median 1- and 5-minute Apgar scores in cases diagnosed prenatally were 8 and 9, respectively, compared with 1 and 4 among survivors in cases not diagnosed prenatally (P < .001). More than half (24 of 41) of surviving neonates born to women without prenatal diagnosis required blood transfusions compared with 2 of 59 diagnosed prenatally (P < .001). Multivariable logistic regression analysis showed that the only significant predictors of neonatal survival were prenatal diagnosis (P < .001) and gestational age at delivery (P = .01). CONCLUSIONS: Good outcomes with vasa previa depend primarily on prenatal diagnosis and cesarean delivery at 35 weeks of gestation or earlier should rupture of membranes, labor, or significant bleeding occur. ( (C) 2004 by The American College of Obstetricians and Gynecologists.).
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页码:937 / 942
页数:6
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