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Q&A

Ultrasound/Imaging

Poster Session 2

(385) Does fetoscopic laser ablation (FLA) improve perinatal outcomes in Types II and III Vasa Previa?

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Sami Backley, MD

    Clinical Fellow PGY 8
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

    • Coauthor(s)

  • Neha Agarwal, MBBS, MD

    Post doctoral Research Fellow
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • LW

    Lindsay Weitzel, BS

    Medical Student
    McGovern Medical School at the University of Texas Health Science Center at Houston
    Houston, TX, United States

  • DL

    Dejian Lai, PhD

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Eric P. Bergh, MD

    Assistant Professor
    McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
    Houston, TX, United States

  • Anthony Johnson, DO

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • Jimmy Espinoza, MD, MSc (he/him/his)

    Professor
    McGovern Medical School at the University of Texas Health Science Center Houston, The Fetal Center- Children’s Memorial Hermann Hospital
    Houston, TX, United States

  • Ramesha Papanna, MD, MPH

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

Objective: The standard management of vasa previa (VP) includes inpatient admission at 28-32 weeks gestation, followed by cesarean delivery at 34-37 weeks gestation. The objective of our study was to compare maternal and neonatal outcomes in patients with Type II and Type III VP undergoing fetoscopic laser ablation (FLA) with those receiving standard of care.  

Study Design:

This was a retrospective study of all antenatally diagnosed cases of VP identified by ultrasound between September 2016 and July 2023 at a single quaternary referral center. Data pertaining to maternal and neonatal characteristics were extracted from ultrasound antenatal scans and maternal and neonatal hospitalization records. Type I VP data were also collected, and descriptive statistics are presented. Comparative analysis was performed between standard care and FLA groups with VP type II/III, with p-value < 0.05 considered significant. Survival was analyzed via Cox Regression model.  



 


Results: A total of 144 pregnancies were identified as suspected VP upon initial ultrasound. Subsequent ultrasound confirmed 89 (61.8%) of these diagnoses of VP. There were 52 (58%) Type I, 29 (33%) Type II, and 8 (9%) Type III VP. Among patients with Type II/III VP, 11/37(30%) underwent FLA. Overall, there were no differences in baseline demographics between groups. The differences between standard and laser therapy in patients with VP type II/III are described in Table 1. Preterm premature rupture of membranes (PPROM) was significantly higher in the FLA group. However, vaginal delivery was also significantly higher in the FLA group (1/3rd of cases), and FLA patients’ maternal antenatal hospital stay was 11 days shorter. Risk of earlier delivery was 44% lower in FLA than standard care (HR 0.56), prolonging pregnancies by 9 days. However, these differences were not statistically significant (p=0.06).

Conclusion: FLA for VP types II and III reduces maternal hospital stay and makes vaginal delivery possible. Other neonatal benefits need further study in larger prospective studies.