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

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.