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Vasa praevia: perinatal outcome in pregnancies with a prenatal diagnosis: systematic review and meta-analysis.

TitleVasa praevia: perinatal outcome in pregnancies with a prenatal diagnosis: systematic review and meta-analysis.
Publication TypeJournal Article
Year of Publication2020
AuthorsZhang, W., Geris S., Al-Emara N., Ramadan G., Sotiriadis A., & Akolekar R.
JournalUltrasound Obstet Gynecol
Date Published2020 Jul 31
ISSN1469-0705
Abstract

OBJECTIVES: To derive accurate estimates of perinatal survival in pregnancies with and without a prenatal diagnosis of vasa praevia from a systematic review of literature and meta-analysis.
METHODS: A search of MEDLINE, EMBASE and CINHAL was performed to review relevant citations reporting perinatal outcomes in pregnancies with vasa praevia. We selected prospective and retrospective cohort and population studies that provided data regarding both women with and without prenatal diagnosis of vasa praevia. Meta-analysis using random effects model was used to derive weighted pooled estimates of perinatal survival [(95% confidence intervals (CI)]. Incidence rate difference (IRD) meta-analysis was used to estimate the significance of difference in pooled proportions. Heterogeneity between studies was estimated using Cochrane's Q and I statistic.
RESULTS: There were 21 studies reporting pregnancy outcome in 683 pregnancies with a prenatal diagnosis of vasa praevia of which there were 3 stillbirths (1.01%; 95% CI: 0.40-1.87), 5 neonatal deaths (1.19%; 95% CI: 0.52-2.12), with 675 neonates who survived with a pooled estimate for perinatal survival of 98.6% (95%CI: 97.6-99.3). Data from seven studies including cases with and without prenatal diagnosis showed that the pooled perinatal survival in cases without 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, if a prenatal diagnosis of vasa praevia was not made antenatally, compared to when it was (OR 25.39; 95% CI: 7.93-81.31). Similar to perinatal deaths, in pregnancies without a prenatal diagnosis, the risk of hypoxic morbidity is increased 50-fold compared to those with a prenatal diagnosis (36/61 without prenatal diagnosis vs. 5/224 with prenatal diagnosis; OR 50.09; 95% CI: 17.33-144.79); the intact perinatal survival in those without a prenatal diagnosis is significantly lower compared to when a prenatal diagnosis is made [28.1% (95%CI: 14.1-44.728.1%) vs. 96.7% (95%CI: 95%CI: 93.6-98.8) (IRD 73.4% (95%CI: 53.9-92.7), Z=-7.4066; p<0.001).
CONCLUSION: Prenatal diagnosis of vasa praevia is associated with a high rate of perinatal survival whereas lack of such an antenatal diagnosis significantly increases the risk of perinatal death and handicap. Further research studies should be undertaken to investigate strategies for incorporating prenatal screening for vasa praevia in routine clinical practice. This article is protected by copyright. All rights reserved.

DOI10.1002/uog.22166
Alternate JournalUltrasound Obstet Gynecol
PubMed ID32735754

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