{
    "abstract": "Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients.\nWe reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non-stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7\u2009days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity.\nOf the 84 antenatally-diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8\u2009weeks, interquartile range (IQR) 33.2-34.3\u2009weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6-36.2] weeks vs. 36.7 [35.6-37.2] weeks, p\u2009=\u20090.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration.\nOur study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor.",
    "authors": [
        {
            "affiliation": "Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.",
            "firstname": "Linda A",
            "initials": "LA",
            "lastname": "Villani"
        },
        {
            "affiliation": "Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.",
            "firstname": "Rashida",
            "initials": "R",
            "lastname": "Al-Torshi"
        },
        {
            "affiliation": "Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.",
            "firstname": "Prakesh S",
            "initials": "PS",
            "lastname": "Shah"
        },
        {
            "affiliation": "Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.",
            "firstname": "John C",
            "initials": "JC",
            "lastname": "Kingdom"
        },
        {
            "affiliation": "Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.\nDepartment of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada.\nDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.",
            "firstname": "Rohan",
            "initials": "R",
            "lastname": "D'Souza"
        },
        {
            "affiliation": "Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.",
            "firstname": "Johannes",
            "initials": "J",
            "lastname": "Keunen"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).",
    "doi": "10.1111/aogs.14595",
    "journal": "Acta obstetricia et gynecologica Scandinavica",
    "keywords": [
        "antenatal corticosteroids",
        "outpatient management",
        "pregnancy",
        "vasa previa"
    ],
    "methods": null,
    "publication_date": "2023-08-04",
    "pubmed_id": "37537788\n33345868\n3543773\n11529988\n17497747\n20872421\n15121568\n24371109\n20560948\n29786153\n26292048\n29079144\n28935064\n19171584\n27741189\n26944186\n28796681\n25153549\n28321847\n30268316\n23023454\n30130820\n8569824\n26070703\n27365003\n28880409\n19173235\n23153020\n29295659",
    "results": "Of the 84 antenatally-diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8\u2009weeks, interquartile range (IQR) 33.2-34.3\u2009weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6-36.2] weeks vs. 36.7 [35.6-37.2] weeks, p\u2009=\u20090.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration.",
    "title": "Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study.",
    "xml": "<Element 'PubmedArticle' at 0x788503097600>"
}