Incidence and causes of perinatal death in prenataly diagnosed Vasa Previa: A systematic review and meta-analysis

To estimate the perinatal mortality associated with prenatally diagnosed vasa previa, and to determine what proportion of those perinatal deaths are directly attributable to vasa previa. PubMed, Scopus, Web of Science, and Embase databases from January 1, 1987 to January 1, 2023. We included all studies (cohort studies and case reports/series) that had patients in which a prenatal diagnosis of vasa previa was made. Case series/reports were excluded from the meta-analysis. All cases in which prenatal diagnosis was not made were excluded from the study. The programming language software R (version 4.2.2) was used to conduct the meta-analysis. The data was logit-transformed and pooled using the fixed-effects model. The between-study heterogeneity was reported by I . The publication bias was evaluated by funnel plot and Peters' regression test. The Newcastle-Ottawa scale was used to assess the risk of bias. Overall, 113 studies with a cumulative sample size of 1297 pregnant individuals were included. There included 25 cohort studies with 1167 pregnancies and 88 case series/reports with 130 pregnancies. Thirteen perinatal deaths occurred among these pregnancies, consisting of two stillbirths and 11 neonatal deaths. Among the cohort studies, the overall perinatal mortality was 0.94% (95% CI: 0.52-1.70, I = 0.0%). The pooled perinatal mortality attributed to vasa previa was 0.51% (95% CI: 0.23-1.14, I = 0.0%). Stillbirth and neonatal death were reported in 0.20% (95% CI: 0.05-0.80, I = 0.0%) and 0.77% (95% CI: 0.40-1.48, I = 0.0%) of pregnancies, respectively. Perinatal death is uncommon after a prenatal diagnosis of vasa previa. About half of the cases of perinatal mortality are not directly attributable to vasa previa. This information will help in guiding physicians in counseling and will provide reassurance to pregnant individuals with a prenatal diagnosis of vasa previa. [Abstract copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Monochorionic diamniotic in vitro fertilization twins have a decreased incidence of twin-to-twin transfusion syndrome.

To compare the incidence of twin-to-twin transfusion syndrome (TTTS) in spontaneous versus IVF-conceived twin pregnancies. Retrospective multicenter study. University-affiliated tertiary medical centers. Women admitted for 11-14 week's scan between January 1997 and July 2013 who were diagnosed with monochorionic (MC) diamniotic twin pregnancies. None. Mode of conception, TTTS. The study cohort included 327 pregnant women with live MC diamniotic twins. Of them, 284 (86.9%) and 43 (13.1%) were spontaneous and IVF conceived, respectively. The mean maternal age was significantly higher in IVF compared with in spontaneously conceived pregnancies (33.8 ± 5.5 vs. 31.6 ± 5.4, respectively). Thirty-seven twins (11.3%) had TTTS, of whom 36/284 (12.7%) versus 1/43 (2.3%) were spontaneously and IVF conceived, respectively. The mean week of delivery was significantly lower in MC twins diagnosed with TTTS compared with those without TTTS (32.7 ± 3.3 vs. 35.5 ± 2.5, respectively). Furthermore, there was a significantly higher birthweight discordancy in twins diagnosed with TTTS compared with those without (20.6% vs. 11%, respectively). The significantly lower proportion of TTTS found in IVF-conceived twins may suggest a different embryological process that lies at the core of IVF conception of monozygotic twinning