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OB
CMECNE

Vasa Previa: Diagnosis and Management

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Define vasa previa
2. Counsel patients about the risk factors associated with vasa previa

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

Vasa previa is defined as fetal vessels that run through the fetal membranes, over or near the endocervical os (2 cm or less) and are unprotected by placenta or umbilical cord.

CLINICAL ACTIONS:

Deliver by cesarean section before the onset of labor and before rupture of membranes

  • Scheduled delivery 34w0d to  37w0d
  • Deliver by cesarean section in the case of PPROM and viability
  • Antenatal corticosteroids 28 to 32 weeks gestation
  • SMFM guidance states to consider hospitalization at 30 to 34 weeks
    • Benefit is unproven and there have been good outcomes reported with outpatient management
    • When considering hospitalization, individualize based on the following
      • Symptoms
      • History of preterm birth
      • Logistics in getting to hospital with transfusion capabilities
    • Patients with normal cervical lengths are the best candidates for possible outpatient management
  • Repeat ultrasound in the third trimester is suggested if vasa previa is suspected in the second trimester, as approximately 20% of apparent vasa previa will resolve by the late third trimester

SYNOPSIS:

Vasa previa occurs in 1/2500-1/5000 pregnancies and is associated with an increased risk of preterm birth and the associated complications of prematurity. There is a 97% survival rate when diagnosed by prenatal ultrasound and a 44% survival rate when the diagnosis is made intrapartum.

KEY POINTS:

  • Risk factors:
    • Velamentous cord insertion (Type 1 vasa previa)
    • Succinturate or bilobed placenta connecting vessels (Type 2 vasa previa)
    • Placenta previa or low lying placenta in the second trimester
    • Multiple gestation
    • IVF (1/250 risk of Type 1 vasa previa)
  • In cases of low lying placenta, bilobed placenta, succinturate placenta or velamentous cord insertion, a targeted ultrasound for vasa previa should be performed
  • Screening possible at 2nd trimester fetal anatomy ultrasound
    • If detected on 2nd trimester ultrasound, 20% will resolve
    • Document cord insertion site if possible
  • Diagnosis is made by ultrasound, ideally with transvaginal and color flow Doppler
  • Ultrasound findings include a linear tubular echolucent body overlying the endocervical os with color flow doppler demonstrating flow through the structure and pulsed doppler showing fetal vascular wave forms
  • Risk of perinatal loss due to fetal exsanguination – watch for sinusoidal pattern on FHT tracing
  • Plan for delivery at a center that can perform neonatal transfusion if required
    • Note: Center should have negative blood available for neonate in case rapid transfusion is necessary

Learn More – Primary Sources:

SMFM: Diagnosis and management of vasa previa

ACOG/SMFM Committee Opinion 764: Medically Indicated Late-Preterm and Early-Term Deliveries

Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: management of bleeding in the late preterm period

Abnormal Placentation: Placenta Previa, Vasa Previa, and Placenta Accreta

Locate a Maternal Fetal Medicine Specialist:

Maternal-Fetal Medicine Specialist Locator-SMFM

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Related ObG Topics:

Placenta Previa – Nomenclature, Diagnosis and Clinical Management
How Effective is Ultrasound in Diagnosing Placenta Accreta?
Latest SMFM Guidelines: Third Trimester Bleeding Between 34w0d and 36w6d Gestation
ACOG Recommendations: When to Deliver Medically Complicated Pregnancies

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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