A diagnostic pitfall: Vasa previa with the fetal vessels running transversely across the cervix

2020 ◽  
Author(s):  
D. Ochiai ◽  
T. Endo ◽  
M. Oishi ◽  
Y. Kasuga ◽  
Sa. Ikenoue ◽  
...  
Keyword(s):  
Diagnostic Pitfall ◽  
Vasa Previa ◽  
Fetal Vessels

Vasa previa: when antenatal diagnosis can change fetal prognosis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Miriam Sutera ◽  
Anna Garofalo ◽  
Eleonora Pilloni ◽  
Silvia Parisi ◽  
Maria Grazia Alemanno ◽  
...  
Keyword(s):  
Risk Factor ◽  
Predictive Value ◽  
Placenta Previa ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Spontaneous Resolution ◽  
Fetal Mortality ◽  
Second Trimester ◽  
Vasa Previa ◽  
Fetal Vessels

Abstract Objectives Evaluate ultrasound diagnostic accuracy, maternal−fetal characteristics and outcomes in case of vasa previa diagnosed antenatally, postnatally or with spontaneous resolution before delivery. Methods Monocentric retrospective study enrolling women with antenatal or postnatal diagnosis of vasa previa at Sant’Anna Hospital in Turin from 2007 to 2018. Vasa previa were defined as fetal vessels that lay 2 cm within the uterine internal os using 2D and Color Doppler transvaginal ultrasound. Diagnosis was confirmed at delivery and on histopathological exam. Vasa previa with spontaneous resolutions were defined as fetal vessels that migrate >2 cm from uterine internal os during scheduled ultrasound follow-ups in pregnancy. Results We enrolled 29 patients (incidence of 0.03%). Ultrasound antenatally diagnosed 25 vasa previa (five had a spontaneous resolution) while four were diagnosed postnatally, with an overall sensitivity of 96.2%, specificity of 100%, positive predictive value of 96.2%, and negative predictive value of 100%. Early gestational age at diagnosis is significally associate with spontaneously resolution (p 0.023; aOR 1.63; 95% IC 1.18–2.89). Nearly 93% of our patient had a risk factor for vasa previa: placenta previa at second trimester or low-lying placenta, bilobated placenta, succenturiate cotyledon, velametous cord insertion or assisted reproduction technologies. Conclusions Maternal and fetal outcomes in case of vasa previa antenatally diagnosed are significally improved. Our data support the evaluation of umbilical cord insertion during routine second trimester ultrasound and a targeted screening for vasa previa in women with risk factor: it allows identification of fetus at high risk, reducing fetal mortality in otherwise healthy newborns.

scholarly journals Placental Types and Effective Perinatal Management of Vasa Previa: Lessons from 55 Cases in a Single Institution

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1369
Author(s):  
Daisuke Tachibana ◽  
Takuya Misugi ◽  
Ritsuko K. Pooh ◽  
Kohei Kitada ◽  
Yasushi Kurihara ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Perinatal Outcomes ◽  
Reproductive Technology ◽  
Single Institution ◽  
Operative Strategy ◽  
Vasa Previa ◽  
Perinatal Management ◽  
Fetal Vessels ◽  
Velamentous Cord Insertion

Background: We aimed to identify clinical characteristics and outcomes for each placental type of vasa previa (VP). Methods: Placental types of vasa previa were defined as follows: Type 1, vasa previa with velamentous cord insertion and non-type 1, vasa previa with a multilobed or succenturiate placenta and vasa previa with vessels branching out from the placental surface and returning to the placental cotyledons. Results: A total of 55 cases of vasa previa were included in this study, with 35 cases of type 1 and 20 cases of non-type 1. Vasa previa with type 1 showed a significantly higher association with assisted reproductive technology, compared with non-type 1 (p = 0.024, 60.0% and 25.0%, respectively). The diagnosis was significantly earlier in the type 1 group than in the non-Type 1 group (p = 0.027, 21.4 weeks and 28.6 weeks, respectively). Moreover, the Ward technique for anterior placentation to avoid injury of the placenta and/or fetal vessels was more frequently required in non-type 1 cases (p < 0.001, 60.0%, compared with 14.3% for type 1). Conclusion: The concept of defining placental types of vasa previa will provide useful information for the screening of this serious complication, improve its clinical management and operative strategy, and achieve more preferable perinatal outcomes.

scholarly journals Vasa previa: a case report

2020 ◽  
Vol 9 (10) ◽  
pp. 4301
Author(s):  
Ipsita Mohapatra ◽  
Subha R. Samantaray ◽  
V. Naga Sindhuja
Keyword(s):  
Neonatal Outcome ◽  
Placenta Previa ◽  
Placental Tissue ◽  
Multiple Pregnancies ◽  
Lower Segment ◽  
Vitro Fertilization ◽  
Vasa Previa ◽  
History Of ◽  
Fetal Vessels

Vasa previa is defined as a condition where fetal vessels traverse the membranes in the lower segment below the presenting part unsupported by placental tissue or umbilical cord. Rupture of the membranes leads to fetal exsanguinations and even neonatal death. The etiology is uncertain, but risk factors include bilobed or succenturiate lobed placenta, velamentous insertion of cord, placenta previa, pregnancies resulting from In vitro fertilization (IVF) and multiple pregnancies. We report here a case of 24 year old woman, G3A2 at 34 weeks of gestation and history of 2 previous spontaneous abortions with vasa previa which was successfully managed. Prenatal sonographic diagnosis has the potential to improve or prevent the poor obstetric and neonatal outcome associated with it.

Ultrastructural evidence of transplacental transport of immunoglobulin G in bitches

Reproduction ◽  
2000 ◽  
pp. 315-326 ◽  
Author(s):  
MH Stoffel ◽  
AE Friess ◽  
SH Hartmann
Keyword(s):  
Mammary Gland ◽  
Basement Membrane ◽  
Immunoglobulin G ◽  
Passive Immunity ◽  
Morphological Evidence ◽  
Membrane Material ◽  
Ultrastructural Evidence ◽  
Cytotrophoblast Cells ◽  
Fetal Vessels

In dogs, passive immunity is conferred to fetuses and neonates by the transfer of maternal immunoglobulin G through the placenta during the last trimester of pregnancy and via the mammary gland after parturition, respectively. However, morphological evidence of transplacental transport is still lacking. The aim of the present study was to localize maternal immunoglobulin G in the labyrinthine zone and in the haemophagous zone of the canine placenta by means of immunohistochemistry and immunocytochemistry. In the labyrinthine zone, immunoglobulin G was detected in all the layers of the materno-fetal barrier including the fetal capillaries. Immunoreactivity was particularly prominent in maternal basement membrane material as well as in the syncytiotrophoblast. However, this evidence of transplacental transport of immunoglobulin G originated from a limited number of unevenly distributed maternal vessels only. In the cytotrophoblast of the haemophagous zone, immunoglobulin G was localized to phagolysosomes at various stages but was never detected within fetal vessels. The results indicate that maternal immunoglobulin G is degraded in cytotrophoblast cells of the hemophagous zone and, therefore, that transplacental transport is restricted to a subpopulation of maternal vessels in the labyrinthine zone.

Prenatal ultrasound diagnosis of velamentous insertion of the umbilical cord: clinical cases and literature review

2018 ◽  
Author(s):  
M.A. Esetov , A.M. Esetov , I.V. Ramazanova
Keyword(s):  
Umbilical Cord ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Ultrasound Diagnosis ◽  
Cesarean Sections ◽  
Previous Cesarean Section ◽  
Vasa Previa ◽  
Obstetrical Management ◽  
Previous Cesarean ◽  
Singleton Pregnancies

Seven cases of ultrasound diagnosis of velamentous insertion (VCI) of the umbilical cord at singleton pregnancies on 21–34 weeks of gestation are presented. The ultrasound picture two of the VIC types is presented: fixed in 5 cases and free in 2 cases. In one case the VCI was in the lower third of the uterus and the wound has been diagnosed the vasa previa. In other cases, the VCI was in middle third of the uterus. In all cases delivery was at 37–39.1 weeks of gestation. In 4 cases Cesarean sections were performed. In two of the VCI cases elective Ce sarean sections were performed for the following indications: previous Cesarean section and vasa previa. VCI can reliably be detected prenatally by gray-scale and color Doppler ultrasound. For fixed VCI located in the middle-upper of the uterus, no change in standard obstetrical management seems to be required.

Points from Letters: Diagnostic Pitfall

BMJ ◽  
1974 ◽  
Vol 1 (5901) ◽  
pp. 248-248
Author(s):  
G. A. Jackson ◽  
P. M. Fea
Keyword(s):  
Diagnostic Pitfall

A case of splenomegaly with RK-39 positivity: A diagnostic pitfall

2021 ◽  
pp. 004947552110206
Author(s):  
Prasad Dange ◽  
Ankesh Gupta ◽  
Richa Juneja ◽  
Renu Saxena
Keyword(s):  
Hereditary Spherocytosis ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Patient Evaluation ◽  
Serological Testing ◽  
Endemic Region ◽  
Careful Patient ◽  
Diagnostic Pitfall ◽  
Marked Splenomegaly

Long-standing moderate to marked splenomegaly suggests several differential diagnoses, both haematological and infectious, particularly leishmaniasis and malaria in endemic areas. Non-infectious causes may be missed in these regions, especially if pitfalls of serological testing are not considered. Careful patient evaluation is necessary to arrive at the correct diagnosis. We report a case of a young male whose hereditary spherocytosis was initially missed because of RK-39 positivity, splenomegaly and the fact that he hailed from an endemic region.

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