99: Fetoscopic laser ablation therapy in type II vasa previa

Abstract

Possible advantages of fetoscopic laser ablation therapy for type II vasa previa compared to traditional conservative management include avoidance of prolonged hospitalization, elective prematurity, and cesarean delivery. The aim of this study was to assess feasibility and outcomes of type II vasa previa patients treated via fetoscopic laser ablation. This is a retrospective study of women with type II vasa previa treated with laser at our center between 2006-2019. After 2010, laser ablation of type II vasa previa was offered after 31 weeks of gestation. Continuous variables are expressed as mean ± standard deviation. During the study period, 33 patients were referred for laser ablation. Fifteen were not candidates (7 had type I vasa previa, 8 had no vasa previa). Of the remaining 18, all with type II vasa previa, 10 (56%) elected to undergo in utero laser. Laser ablation of the vasa previa vessel(s) was successful in all 10 patients. The overall mean gestational age (GA) at the time of the procedure was 28.8 ± 5.4 weeks and the total operative time was 48.1 ± 21.3 minutes; there were no perioperative complications. The number of vessels lasered were distributed as follows: 1 (2 cases), 2 (5 cases), and 3 (3 cases). Nine patients were subsequently managed as outpatients, and 1 patient with twins in preterm labor was managed as an inpatient. The mean GA of delivery was 35.5 ± 3.2 weeks, and vaginal delivery occurred in 5 cases. After protocol change in 2010, 5 laser ablations for singletons with type II vasa previa were performed with the following outcomes: mean GA of surgery was 32.5 ± 0.8 weeks, mean GA at delivery was 38.1 ± 1.4 weeks, vaginal delivery occurred in all cases, birthweight was 2965 ± 596 grams, and no newborns were admitted to the neonatal intensive care unit. This cohort represents the largest number of type II vasa previa cases treated via laser reported to date. Laser occlusion of type II vasa previa was technically achievable and resulted in favorable outcomes.