{"title":"Vasa Previa: Factors Associated with Inpatient versus Outpatient Antepartum Management.","authors":"Sarah B Heaps, Stephen T Chasen","doi":"10.1055/a-2620-7780","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>When vasa previa is diagnosed, guidelines support recommendations about timing and route of delivery, as well as steroid administration. While elective admission to ensure proximity to care is common, evidence does not support a clear recommendation. Our objective was to compare patients with vasa previa managed as inpatients vs outpatients.</p><p><strong>Study design: </strong>This is a single institution cohort study of patients with a prenatal diagnosis of vasa previa from 2013-2023. Decisions about inpatient vs. outpatient management and delivery planning were made by physicians and patients. Data was obtained through chart review. Cohorts managed with elective admission for vasa previa were compared with those managed as outpatients. Mann-Whitney U and Fisher's Exact test were used for statistical comparison.</p><p><strong>Results: </strong>89 patients were included, including 72 (80.9%) electively admitted vs. 17 (19.1%) managed as outpatients. The groups were of similar age and parity. A higher proportion of patients managed as outpatients had public insurance. There were no differences in the rate of short cervix or vaginal bleeding between the cohorts, and the rates of non-scheduled Cesarean Delivery were similar. Betamethasone was administered at a median gestational age of 32-33 weeks in both groups. Elective admission was associated with earlier delivery overall, as well as earlier scheduled delivery. There were no stillbirths or neonatal deaths, and the rates of NICU admission were not significantly different.</p><p><strong>Conclusion: </strong>Patients electively admitted for vasa previa do not appear to have been at higher risk for emergent delivery, though admission was associated with earlier delivery, including scheduled deliveries. The lower rate of admission in those with public insurance could indicate a disparity in management, though further study is necessary. While our data do not rule out a benefit to routine admission, the benefits remain unproven.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2620-7780","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: When vasa previa is diagnosed, guidelines support recommendations about timing and route of delivery, as well as steroid administration. While elective admission to ensure proximity to care is common, evidence does not support a clear recommendation. Our objective was to compare patients with vasa previa managed as inpatients vs outpatients.
Study design: This is a single institution cohort study of patients with a prenatal diagnosis of vasa previa from 2013-2023. Decisions about inpatient vs. outpatient management and delivery planning were made by physicians and patients. Data was obtained through chart review. Cohorts managed with elective admission for vasa previa were compared with those managed as outpatients. Mann-Whitney U and Fisher's Exact test were used for statistical comparison.
Results: 89 patients were included, including 72 (80.9%) electively admitted vs. 17 (19.1%) managed as outpatients. The groups were of similar age and parity. A higher proportion of patients managed as outpatients had public insurance. There were no differences in the rate of short cervix or vaginal bleeding between the cohorts, and the rates of non-scheduled Cesarean Delivery were similar. Betamethasone was administered at a median gestational age of 32-33 weeks in both groups. Elective admission was associated with earlier delivery overall, as well as earlier scheduled delivery. There were no stillbirths or neonatal deaths, and the rates of NICU admission were not significantly different.
Conclusion: Patients electively admitted for vasa previa do not appear to have been at higher risk for emergent delivery, though admission was associated with earlier delivery, including scheduled deliveries. The lower rate of admission in those with public insurance could indicate a disparity in management, though further study is necessary. While our data do not rule out a benefit to routine admission, the benefits remain unproven.
期刊介绍：
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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