Susan Lashley

Vasa previa: the impact of prenatal diagnosis on outcomes.

OBJECTIVE: To evaluate outcomes and predictors of neonatal survival in pregnancies complicated by vasa previa and to compare outcomes in prenatally diagnosed cases of vasa previa with those not diagnosed prenatally. METHODS: We performed a multicenter study of 155 pregnancies complicated by vasa previa. Cases were obtained from the Vasa Previa Foundation and 6 large hospitals. Comparisons were made between groups based on prenatal diagnosis status and neonatal survival. RESULTS: The overall perinatal mortality was 36% (55 of 155). In 61 cases (39%), vasa previa was diagnosed prenatally; 59 of 61 (97%) infants from these pregnancies survived compared with 41 of 94 (44%) in cases not diagnosed prenatally (P < .001). Median 1- and 5-minute Apgar scores in cases diagnosed prenatally were 8 and 9, respectively, compared with 1 and 4 among survivors in cases not diagnosed prenatally (P < .001). More than half (24 of 41) of surviving neonates born to women without prenatal diagnosis required blood transfusions compared with 2 of 59 diagnosed prenatally (P < .001). Multivariable logistic regression analysis showed that the only significant predictors of neonatal survival were prenatal diagnosis (P < .001) and gestational age at delivery (P = .01). CONCLUSIONS: Good outcomes with vasa previa depend primarily on prenatal diagnosis and cesarean delivery at 35 weeks of gestation or earlier should rupture of membranes, labor, or significant bleeding occur. LEVEL OF EVIDENCE: II-3

Prenatal Sonographic Findings Associated With Nonmosaic Trisomy 9 and Literature Review

T risomy 9 was first reported in 1973 through blood lymphocyte testing in a newborn male with multiple congenital anomalies. 1 Since that time, only approximately 30 cases of mosaic or nonmosaic trisomy 9 have been reported 2 ; therefore, this is a relatively rare chromosomal abnormality, constituting only 2.7% of all trisomic cases. 3 Nonmosaic or complete trisomy 9 is a lethal diagnosis, with most fetuses dying prenatally or during the early postnatal period. Those who survive usually have mosaic trisomy 9 and have severe motor and mental deficiencies. With mosaic trisomy 9, the prevalence and severity of malformations and mental deficiency correlate with the percentages of trisomic cells in different tissues. 4 4 Because most complete trisomy 9 cases end in spontaneous abortion in the first trimester, there is a paucity of reports regarding the prenatal sonographic findings of complete trisomy 9. To our knowledge, only 7 cases of nonmosaic trisomy 9 that were specifically detected on prenatal sonography have been reported in the literature: first trimester (n = 2), second trimester (n = 2), and third trimester (n = 3). 3,5-9 There are distinct features associated with complete trisomy 9. Clinical and sonographic findings that have been described include intrauterine growth restriction, central nervous system abnormalities, cranial and facial anomalies, skeletal defects, congenital heart defects, and urogenital abnormalities. 6.8 8 The purpose of this report is to describe the prenatal sonographic findings in a second-trimester fetus with trisomy 9 and also to review the sonographic findings of all published cases of nonmosaic trisomy 9 that were specifically detected on sonography.

Vasa Previa: Prenatal Diagnosis and Outcomes: Thirty‐five Cases From a Single Maternal‐Fetal Medicine Practice

To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa.

Physiologic proteinuria in labor and postpartum: The results of the Postpartum Proteinuria Trial (PoPPy)

The urine protein to creatinine ratio (PC) is a sensitive and specific means of diagnosing preeclampsia in the antepartum period, but the 0.3 g protein per gram of creatinine threshold may be non-specific postpartum due to physiologic proteinuria after delivery. The objective of this study was to examine the reliability of PC in labor and postpartum and to determine if PC is affected by mode of delivery. This is the first study of its kind to examine physiologic proteinuria by catheterized PC in individual patients before and after delivery. This single-center prospective cohort study included two groups: term uncomplicated nulliparous patients in labor with epidural analgesia and patients for scheduled repeat cesarean deliveries. Patients with hypertension, antepartum proteinuria, renal disease, gross hematuria, or evidence of infection were excluded. Catheterized pre- and post-delivery urine PC were compared using paired t-tests. 27 and 40 patients were included in the vaginal and cesarean delivery groups, respectively. 52% of the vaginal delivery and 58% of the cesarean delivery groups were positive for proteinuria at the 0.3 g protein per g creatinine threshold. Pre- and post-delivery specimens were significantly different in the vaginal (mean difference 0.28, p = 0.05) and cesarean (mean difference 0.25, p < 0.01) delivery groups. The conclusions reached included the finding that PC measurements are unreliable in the immediate postpartum period regardless of mode of delivery, and utilizing the 0.3 threshold to diagnose preeclampsia in close proximity to delivery would contribute to increased false positive tests.