332: Variation in outcome reporting in studies on Vasa Previa: A Systematic Review

Abstract

To evaluate outcomes reported in studies on the antenatal diagnosis and management of Vasa Previa. MEDLINE, EMBASE, COCHRANE, PubMed and Clinicaltrials.gov were searched up to the March of 2018 for all published studies on Vasa Previa using combinations of the following MeSH and keyword terms: vasa previa, placenta previa, low lying placenta, succenturiate lobe or placenta, bilobed or bilobate placenta, velamentous insertion. Title/abstract screening and data extraction was conducted independently and in duplicate by two reviewers for all studies until total agreement for eligibility was achieved. Data extraction was also conducted in duplicate for over 60% of studies reviewed. All original human research that described maternal/obstetric and fetal/neonatal outcomes relating to pregnancies with Vasa Previa were included for analysis. In total, 160 published studies were examined for outcomes that pertained to pregnancies with Vasa Previa. There was a wide range of reported outcomes, many of which were reported sparingly. The most commonly reported maternal outcomes included the mode of delivery, presence of antepartum hemorrhage, time of diagnosis, rupture of membranes, and presence of known risk factors such as a low-lying placenta, succenturiate or bi-lobed placenta and (velamentous) cord insertion. The most commonly reported fetal/neonatal outcomes included fetal heart rate, gestational age at delivery, birth weight, Apgar score, presence of neonatal anemia, cord gas measurements, need for blood transfusion and death. Importantly, only three studies reported on data related to life impacts, such maternal social and emotional functioning, perceived delivery of care or resource utilization. Despite the profound effect a diagnosis of Vasa Previa has on pregnant women, families, and healthcare systems, outcomes related to life impact and resource utilization were seldom reported. There is need for development of a core outcome set, a minimum standard set of outcomes that takes into account outcomes considered important by pregnant women with Vasa Previa as well as other stakeholders involved in their care.