Nothing Special   »   [go: up one dir, main page]
Scribd Logo
Upload

Welcome to Scribd!

  • 30 views

    Vasa Previa (Manejo)

    Uploaded by

    Estefania Gutierrez
    This letter to the editors summarizes key points about diagnosing and managing vasa previa that were omitted from a recent article. It notes that vasa previa can be diagnosed if any unprotected fetal vessels are found in the membranes over or near the cervix, not just arteries. It emphasizes the importance of an accurate prenatal diagnosis, as failure to diagnose can result in death for over half of babies with vasa previa. The letter urges caution for any velamentous vessels near the cervix and provides recommendations to minimize missed or false diagnoses of vasa previa.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Vasa Previa (Manejo)

    Uploaded by

    Estefania Gutierrez
    30 views1 page
    This letter to the editors summarizes key points about diagnosing and managing vasa previa that were omitted from a recent article. It notes that vasa previa can be diagnosed if any unprotected fetal vessels are found in the membranes over or near the cervix, not just arteries. It emphasizes the importance of an accurate prenatal diagnosis, as failure to diagnose can result in death for over half of babies with vasa previa. The letter urges caution for any velamentous vessels near the cervix and provides recommendations to minimize missed or false diagnoses of vasa previa.

    Original Description:

    Revista de ginecologia y obstetricia 2020

    Original Title

    vasa previa (Manejo)

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This letter to the editors summarizes key points about diagnosing and managing vasa previa that were omitted from a recent article. It notes that vasa previa can be diagnosed if any unprotected fetal vessels are found in the membranes over or near the cervix, not just arteries. It emphasizes the importance of an accurate prenatal diagnosis, as failure to diagnose can result in death for over half of babies with vasa previa. The letter urges caution for any velamentous vessels near the cervix and provides recommendations to minimize missed or false diagnoses of vasa previa.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views1 page

    Vasa Previa (Manejo)

    Uploaded by

    Estefania Gutierrez
    This letter to the editors summarizes key points about diagnosing and managing vasa previa that were omitted from a recent article. It notes that vasa previa can be diagnosed if any unprotected fetal vessels are found in the membranes over or near the cervix, not just arteries. It emphasizes the importance of an accurate prenatal diagnosis, as failure to diagnose can result in death for over half of babies with vasa previa. The letter urges caution for any velamentous vessels near the cervix and provides recommendations to minimize missed or false diagnoses of vasa previa.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Letters to the Editors ajog.

    org

    Diagnosis and management of vasa previa


    TO THE EDITORS: We very much enjoyed the recent article
    FIGURE
    in the Society for Maternal-Fetal Medicine Consult series
    regarding diagnosis and management of vasa previa1 but Transvaginal ultrasound image with color Doppler
    would like to point out several key omissions. showing vasa previa
    The authors state that “the diagnosis of vasa previa is
    confirmed if an arterial vessel is visualized over the cervix. .”
    This criterion is also given in a recent article by Silver2 but is
    not accurate. Vasa previa is diagnosed if there are any
    unprotected fetal vessels in the membranes over or near the
    cervix, with either an arterial waveform or venous flow.
    Fetal veins are thin walled and hence potentially more
    prone to rupture; prior to the advent of sonographic diag-
    nosis, one of us (V.C.) treated a case in which near exsan-
    guination occurred within minutes of the rupture of
    membranes because of the rupture of venous vasa previa.
    When venous flow is seen, the sonographer must confirm
    that the flow is indeed within a fetal vessel by tracking the
    vessel back to the placenta with color Doppler or color power
    angioscanning.
    Vasa previa is the most important sonographic diagnosis
    for the fetus: more than half of the 1 in 2500 babies with vasa The arrowheads indicate the internal cervical os and external os.
    previa, and half of the 1 in 250 babies from in vitro fertil-
    ization with vasa previa, die if the diagnosis is not made.3 We
    can think of no other condition in which an accurate prenatal vasa previa, it is crucial that the cervix should be clearly
    diagnosis leads to such a dramatic difference between death demonstrated and the vessels should not be encased by
    and survival.3,4 The authors state that “routine ultrasound cord or overlying the placental tissue. Above is one such
    examination of the placenta and lower uterine segment per- image (Figure). -
    mits detection in the majority of cases.”
    Val Catanzarite, MD
    The diagnosis may be missed if fetal parts obscure the San Diego Perinatal
    cervix or if incorrect color Doppler settings are used.4 Fetal 7910 Frost Street
    vessels running transversely or obliquely across the cervix or San Diego, CA 92123
    lower uterine segment are easiest to miss but will be appre-
    Yinka Oyelese, MD
    ciated by angling the transducer from the side.
    Atlantic Maternal Fetal Medicine
    Whereas the authors discuss a threshold of a 2 cm distance
    Morristown, NJ 07932
    between the vessels and the internal os, we are aware of Yinkamd@aol.com
    several cases of fatal fetal vessel rupture with fetal vessels as far
    The authors report no conflict of interest.
    as 4 cm from the internal os. The fetal biparietal diameter is
    9.5 cm at term; hence, any vessel within a radius of 5 cm from
    REFERENCES
    the internal os is potentially in jeopardy. Because we do not
    1. Society for Maternal Fetal Medicine Publications Committee. SMFM
    have a specific distance that places vessels at low risk for Consult Series number 37. Diagnosis and management of vasa previa.
    rupture, we would urge extreme caution in dealing with any Am J Obstet Gynecol 2015:615-9.
    velamentous vessels in the lower segment. 2. Silver R. Abnormal placentation: placenta previa, vasa previa, and
    Finally, the images in the article are not ideal. Vasa placenta accreta. Obstet Gynecol 2015;126:654-8.
    previa refers to fetal vessels running through the mem- 3. Oyelese Y, Catanzarite V, Prefumo F, et al. Vasa previa: the impact
    of prenatal diagnosis on outcomes. Obstet Gynecol 2004;103(5 Pt 1):
    branes over the cervix, unprotected by cord or placental
    937-42.
    tissue. The images presented show a fetal vessel overlying a 4. Catanzarite V, Maida C, Thomas W, Mendoza A, Stanco L,
    thickened uniformly echogenic structure that may be Piacquadio KM. Prenatal sonographic diagnosis of vasa previa: ultra-
    placenta or myometrium. The echolucent structure to the sound findings and obstetric outcome in ten cases. Ultrasound Obstet
    upper right of both images does not appear to be the Gynecol 2001;18:109-15.
    bladder. No clear landmarks are shown. For accurate ª 2016 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.ajog.2016.
    diagnosis, and to minimize the false-positive diagnosis of 02.012

    764 American Journal of Obstetrics & Gynecology JUNE 2016

    You might also like