Vasa Previa: Factors Associated with Inpatient versus Outpatient Antepartum Management.

Abstract

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, the evidence does not support a clear recommendation. Our objective was to compare patients with vasa previa managed as inpatients versus outpatients.This is a single-institution cohort study of patients with a prenatal diagnosis of vasa previa from 2013 to 2023. Decisions about inpatient versus 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.Eighty-nine patients were included, including 72 (80.9%) electively admitted versus 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 nonscheduled cesarean delivery were similar. Betamethasone was administered at a median gestational age of 32 to 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.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. · Inpatient admission was associated with earlier gestational age at delivery.. · Inpatient versus outpatient management showed no difference in neonatal morbidity.. · Rates of unscheduled (urgent or emergent) delivery were not significantly different between groups..