Vasa previa screening, diagnosis, management and outcomes: single‐center study

ABSTRACT Objective The aim of the present study was to describe the diagnosis, management and outcomes of patients with prenatally diagnosed vasa previa (VP) at a single center in which routine VP screening is performed. Methods We carried out a retrospective cohort study of all patients with prenatally diagnosed VP at our institution (Beth Israel Deaconess Medical Center, Boston, MA, USA) between January 2010 and October 2024. We routinely screen all patients at the second‐trimester anatomy scan by transabdominal ultrasound identification of the placental cord insertion and a color flow Doppler sweep over the cervix. We also routinely perform transvaginal ultrasound with color flow Doppler in all patients with a second‐trimester low‐lying placenta or placenta previa. We confirm all diagnoses in the third trimester, at approximately 32 weeks' gestation. Patients with VP were identified from the ultrasound and hospital databases. The primary outcome was perinatal survival in the screened patients, and we also compared neonatal outcomes between patients delivered < 36 or ≥ 36 weeks. Results There were 205 patients (189 singleton and 16 twin gestations) with prenatally diagnosed VP during the study period. Resolution occurred in 25 (12.2%) patients, and delivery records were unavailable for six, leaving 174 patients with unresolved VP at delivery, all of whom were diagnosed prenatally. To our knowledge, there were no false‐positive or false‐negative diagnoses. All patients underwent Cesarean delivery, at a median gestational age of 35.1 (interquartile range, 34.6–35.9) weeks. All except one of the pregnancies resulted in live birth. The single death occurred in one of a set of monochorionic diamniotic twins that underwent laser photocoagulation for twin–twin transfusion syndrome. Delivery ≥ 36 weeks resulted in improved neonatal outcomes when compared with patients delivering < 36 weeks. Conclusions This study found almost universal perinatal survival in cases of prenatally diagnosed VP in a center with routine screening protocols for VP. These findings strongly support the implementation of a screening program for VP, which has the potential to significantly reduce the high rate of stillbirth associated with this condition. We do not, however, recommend delivery after 37 weeks' gestation. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.