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Abstract
INTRODUCTION: The objective of this study was to determine the optimal gestational age for delivery in cases of vasa previa. METHODS: A decision-analytic model was designed to compare gestational age of delivery in vasa previa for gestational ages between 32 and 37 weeks using maternal and fetal quality-adjusted life-years in a theoretical cohort of 1,000 women with vasa previa. At each week of gestational age, we allowed for different delivery strategies: 1) premature labor with emergent delivery or 2) planned delivery by cesarean at a predetermined gestational age. Quality-adjusted life-years were calculated based on the probability of fetal bleed or no fetal bleed, with or without development of cerebral palsy, stillbirth, or uncomplicated fetal delivery. RESULTS: Delivery at 33 weeks of gestation for women with vasa previa optimizes maternal and neonatal outcomes, resulting in 6.98 stillbirths per 1,000 and 12.2 cases of cerebral palsy per 1,000. Delivery at 33 weeks of gestation maximizes total quality-adjusted life-years at 56.4. CONCLUSION: Delivery at 33 weeks of gestation for women with vasa previa optimizes maternal and fetal outcomes.
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