Vasa Previa: A New Paradigm in Patient Hospitalization, Timing of Delivery and Corticosteroid Use [11A]

INTRODUCTION: Vasa Previa occurs when fetally-derived umbilical cord vessels cross the internal os of the cervix. The aim of this study was to evaluate parameters that influence outpatient versus inpatient management in these cases. METHODS: Research Ethics Board approval was obtained for this study. Consecutive cases of vasa previa as diagnosed at Mount Sinai Hospital, Toronto from January 2008 to December 2017 were retrospectively reviewed. Cases were categorized into 3 arms for analysis: outpatients (OP), indicated hospitalized (IH) and non-indicated hospitalized (NIH). The NIH arm included asymptomatic patients admitted for surveillance, while the IH arm included symptomatic patients admitted for antepartum hemorrhage. RESULTS: 84 cases of vasa previa were diagnosed during the study period. The IH group was admitted a median of 22.5 days longer vs the NIH group up to delivery. The IH group had the highest frequency of unplanned caesareans at 46.2%, vs 7.1% and 11.1% of cases in the NIH and OP groups, respectively. Despite having an equal number of unplanned caesareans, the NIH group delivered a median 1.7 weeks earlier vs the OP group (P=.0040). NIH patients were also more than twice as likely to receive corticosteroid therapy inappropriately vs the OP group (57.1% vs 27.8%, P=.0359). A median (IQR) of 5 (3.5-7.6) weeks between corticosteroid administration and delivery existed among patients who received this therapy inappropriately. CONCLUSION: Our evidence suggests that physicians have difficulty predicting imminent preterm delivery for proper corticosteroid use in this population, but may be able to offer asymptomatic patients the option of outpatient management.