193: Prenatal diagnosis of vasa previa: Outpatient versus inpatient management

Abstract

The optimal antenatal management and the timing of delivery in women with prenatal diagnosis of vasa previa have not been established. The aim of this study was to compare pregnancy outcome of two different management strategies (outpatient versus inpatient) and a policy of elective cesarean section at 36 weeks of gestation in pregnancies complicated with vasa previa This was a retrospective cohort study conducted at a single tertiary center. All women with a prenatally diagnosed vasa previa between 01/2007-05/2017 were included. Vasa previa was confirmed by serial ultrasound examinations and placental examination. Obstetric and neonatal outcomes were compared between two management strategies: elective admission at 34.0 weeks of gestation or outpatient management unless there were signs of labor or premature contractions. All women had a planned cesarean delivery at 36 weeks. 109 women met inclusion criteria: 75 (68.8%) women in the inpatient group and 34 (31.2%) in the outpatient group. Women in the inpatient group were admitted earlier (34.0 vs 35.3 weeks, respectively, P=0.002) and were more likely to be delivered earlier (36.0 vs 36.2 weeks, respectively, P=0.01) compared to outpatient group. Women in the inpatient group were more likely to receive antenatal steroids (57.3% vs 23.5%, respectively, P=0.002), but less likely to have an urgent cesarean section (18.9% vs 58.8%, respectively, P<0.001). However, the rate of cesarean before 36 weeks of gestation was similar between the two groups (34.7% vs 31.6%, respectively, P=0.8) and there was no significant difference in the rate of operative complications (18.9% vs 14.7%, respectively P=0.65) or post-partum complications (12.0% vs 26.5%, P= 0.09) between the groups. There was no difference in the rate of neonatal complications (inpatient: 68.9% vs outpatient: 57.5%, P=0.255) or neonatal anemia requiring transfusion (2.7% vs 5.8%, respectively, P=0.5) between the groups. There was one case of neonatal death due to severe intrauterine growth restriction. A policy of planned cesarean delivery at 36 weeks of gestation in cases with prenatally diagnosed vasa previa is safe, however, it is prudent to recommend elective inpatient hospitalization at 34 weeks of gestation as the rate of urgent cesarean section was higher in women managed as outpatients compared to those managed as inpatient.