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Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To investigate the fetal heart rate (FHR) patterns in pregnancies complicated with vasa previa and velamentous cord insertion (VCI).

Methods

A retrospective study comparing FHR patterns in pregnancies and subsequent pregnancies with/without VCI and in pregnancies with/without vasa previa was conducted. For each patient, FHR patterns were compared to the subsequent pregnancy. Deliveries occurred between the years 1988 and 2012 in a tertiary medical center. FHR patterns were evaluated according to the ACOG guidelines.

Results

During the study period, there were 184 pregnancies with VCI and 37 pregnancies with vasa previa, undetected during pregnancy. FHR patterns of the VCI group included more cases of abnormal baseline (7 vs. 2 %, p < 0.05), out of which 7 % were fetal tachycardia (vs. 2 %) and 4 % were bradycardia (vs. 1 %). There were also more cases of abnormal baseline and abnormal variability (7 vs. 2 % and 32 vs. 22 %, respectively, p < 0.05) in the VCI group. FHR categories also differed between the velamentous cord insertion pregnancies and subsequent ones. VCI pregnancies had more category 2 patterns, not statistically significant (64 vs. 55 %, p = 0.11). FHR patterns of the vasa previa group included more cases of abnormal baseline (27 vs. 7 %, p < 0.05), out of which 18 % were tachycardia and 9 % were bradycardia. Decelerations were recorded in a total of 61 % of the vasa previa cases (61 vs. 31 %, p = 0.02), most of which were variable decelerations (48 vs. 17 %). Vasa previa pregnancies had more category 2 patterns (64 vs. 52 %).

Conclusions

Fetal heart rate patterns in pregnancies complicated with VCI or vasa previa have several non-specific pathological characteristics; none can be used for early detection of these conditions.

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References

  1. Catanzarite V, Maida C, Thomas W et al (2001) Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol 18:109

    Article  PubMed  CAS  Google Scholar 

  2. Lee W, Lee VL, Kirk JS et al (2000) Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome. Obstet Gynecol 95:572

    Article  PubMed  CAS  Google Scholar 

  3. Francois K, Mayer S, Harris C, Perlow JH (2004) Association of vasa previa at delivery with a history of second-trimester placenta previa. Obstet Gynecol Surv 59:245

    Article  Google Scholar 

  4. Bronsteen R, Whitten A, Balasubramanian M et al (2013) Vasa previa: clinical presentations, outcomes, and implications for management. Obstet Gynecol 122:352

    Article  PubMed  Google Scholar 

  5. Oyelese Y, Spong C, Fernandez MA, McLaren RA (2000) Second trimester low-lying placenta and in vitro fertilization? Exclude vasa previa. J Matern Fetal Med 9:370

    PubMed  CAS  Google Scholar 

  6. Schachter M, Tovbin Y, Arieli S et al (2002) In vitro fertilization is a risk factor for vasa previa. Fertil Steril 78:642

    Article  PubMed  Google Scholar 

  7. Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E (2011) Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 284(1):47–51

    Article  PubMed  Google Scholar 

  8. Baulies S, Maiz N, Muñoz A et al (2007) Prenatal ultrasound diagnosis of vasa praevia and analysis of risk factors. Prenat Diagn 27:595

    Article  PubMed  CAS  Google Scholar 

  9. Al-Khaduri M, Kadoch IJ, Couturier B et al (2007) Vasa praevia after IVF: should there be guidelines? Report of two cases and literature review. Reprod Biomed Online 14:372

    Article  PubMed  Google Scholar 

  10. Suzuki S, Igarashi M (2008) Arch Gynecol Obstet. Clinical significance of pregnancies with succenturiate lobes of placenta 277(4):299–301 Epub 2007 Oct 16

    Google Scholar 

  11. Hasegawa J, Farina A, Nakamura M et al (2010) Analysis of the ultrasonographic findings predictive of vasa previa. Prenat Diagn 30:1121

    Article  PubMed  Google Scholar 

  12. Abramowicz JS, Sheiner E (2008) Ultrasound of the placenta: a systematic approach. Part II: functional assessment (Doppler). Placenta 29(11):921–929

    Article  PubMed  CAS  Google Scholar 

  13. Smorgick N, Tovbin Y, Ushakov F, Vaknin Z, Barzilay B, Herman A, Maymon R (2010) Is neonatal risk from vasa previa preventable? The 20-year experience from a single medical center. J Clin Ultrasound 38(3):118–22. doi: 10.1002/jcu.20665

  14. Gantt PA, Bird JS Jr, Randall GW (1990) Sinusoidal fetal heart rate pattern with vasa previa. J Tenn Med Assoc 83(8):393–4

  15. Odunsi K, Bullough CH, Henzel J, Polanska A (1996) Evaluation of chemical tests for fetal bleeding from vasa previa. Int J Gynaecol Obstet 55(3):207

    Article  PubMed  CAS  Google Scholar 

  16. Benirschke K, Kaufmann P (2000) Pathology of the Human Placenta. Springer-Verlag, New York, pp 353–359

    Book  Google Scholar 

  17. Kouyomdjian A (1980) Velamentous insertion of the umbilical cord. Obstet Gynecol 56(6): 737-742

  18. Heinonen S, Ryynänen M, Kirkinen P, Saarikoski S (1996) Perinatal diagnostic evaluation of velamentous umbilical cord insertion: clinical, Doppler, and ultrasonic findings. Obstet Gynecol 87(1):112–117

    Article  PubMed  CAS  Google Scholar 

  19. American College of Obstetricians and Gynecologists (2009) Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 114(1):192–202. doi:10.1097/AOG.0b013e3181aef106

    Article  Google Scholar 

  20. Hasegawa J, Matsuoka R, Ichizuka K, Sekizawa A, Farina A, Okai T (2005) Velamentous cord insertion and atypical variable decelerations with no accelerations. Int J Gynaecol Obstet 90(1):26–30

    Article  PubMed  CAS  Google Scholar 

  21. Ebbing C, Kiserud T, Johnsen SL, Albrechtsen S, Rasmussen S (2013) Prevalence, risk factors and outcomes of velamentous and marginal cord insertions: a population-based study of 634,741 pregnancies. PLoS One 8(7):e70380. doi:10.1371/journal.pone.0070380

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Räisänen S, Georgiadis L, Harju M, Keski-Nisula L, Heinonen S (2012) Risk factors and adverse pregnancy outcomes among births affected by velamentous umbilical cord insertion: a retrospective population-based register study. Eur J Obstet Gynecol Reprod Biol 165(2):231–234. doi:10.1016/j.ejogrb.2012.08.021 Epub 2012 Sep 1

    Article  PubMed  Google Scholar 

  23. Timmins AE, Clark SL (2015) How to approach intrapartum category II tracings. Obstet Gynecol Clin North Am 42(2):363–375. doi:10.1016/j.ogc.2015.01.013

    Article  PubMed  Google Scholar 

  24. Costa MD, Schnettler WT, Amorim-Costa C, Bernardes J, Costa A, Goldberger AL, Ayres-de-Campos D (2014) Complexity-loss in fetal heart rate dynamics during labor as a potential biomarker of acidemia. Early Hum Dev. 90(1):67–71. doi:10.1016/j.earlhumdev.2013.10.002 Epub 2013 Nov 28

    Article  PubMed  PubMed Central  Google Scholar 

  25. Frasch MG, Keen AE, Gagnon R, Ross MG, Richardson BS (2011) Monitoring fetal electrocortical activity during labour for predicting worsening acidemia: a prospective study in the ovine fetus near term. PLoS One 6(7):e22100. doi: 10.1371/journal.pone.0022100. Epub 2011 Jul 15

  26. Apel-Sarid L, Levy A, Holcberg G, Sheiner E (2010) Term and preterm (<34 and <37 weeks gestation) placental pathologies associated with fetal growth restriction. Arch Gynecol Obstet 282(5):487–492

    Article  PubMed  Google Scholar 

  27. Apel-Sarid L, Levy A, Holcberg G, Sheiner E (2009) Placental pathologies associated with intra-uterine fetal growth restriction complicated with and without oligohydramnios. Arch Gynecol Obstet 280(4):549–552

    Article  PubMed  Google Scholar 

  28. Koifman A, Levy A, Zaulan Y, Harlev A, Mazor M, Wiznitzer A, Sheiner E (2008) The clinical significance of bleeding during the second trimester of pregnancy. Arch Gynecol Obstet 278(1):47–51 Epub 2007 Dec 8

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Be’er-Sheva, Israel

    Yael Baumfeld, Gil Gutvirtz, Iris Shoham & Eyal Sheiner

  2. Department of Obstetrics and Gynecology, Soroka University Medical Center, POB 151, Beer Sheva, 84101, Israel

    Eyal Sheiner

Authors
  1. Yael Baumfeld
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  2. Gil Gutvirtz
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  3. Iris Shoham
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  4. Eyal Sheiner
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Correspondence to Eyal Sheiner.

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Baumfeld, Y., Gutvirtz, G., Shoham, I. et al. Fetal heart rate patterns of pregnancies with vasa previa and velamentous cord insertion. Arch Gynecol Obstet 293, 361–367 (2016). https://doi.org/10.1007/s00404-015-3819-6

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  • DOI: https://doi.org/10.1007/s00404-015-3819-6

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