Poster Session 2
Category: Fetal Intervention
Poster Session 2
Adriana S. Mockler, N/A
Keck School of Medicine of USC, University of Southern California
Los Angeles, California, United States
Randy Mohtar, BS
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
Los Angeles, California, United States
Arlyn S. Llanes, MHA, RN
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Lisa M. Korst, MD, PhD
Childbirth Research Associates
North Hollywood, California, United States
.jpg "Alireza A. Shamshirsaz, MD (he/him/his) photo")
Alireza A. Shamshirsaz, MD (he/him/his)
Department Director, Professor of Surgery
Boston Children's Hospital, Harvard Medical School
Boston, Massachusetts, United States
Ramen H. Chmait, MD (he/him/his)
Director, Los Angeles Fetal Surgery; Professor, Department of Obstetrics and Gynecology
Keck School of Medicine of USC, University of Southern California
Keck School of Medicine of USC, University Of Southern California, California, United States
Fetoscopic laser ablation is a novel therapeutic treatment for Types II and III vasa previa (VP), a condition where fetal blood vessels traverse near the internal cervical os, unsupported by underlying placenta. VP connecting the main placenta to an accessory lobe is classified as Type II, and a VP that exits and reenters the same placenta is classified as Type III. We compared patient characteristics and outcomes after laser ablation of Type II vs Type III VP.
Study Design:
This was a retrospective cohort study (2013-2025) comparing pregnancy, surgical, and neonatal outcomes of singleton pregnancies with Types II and III VP after laser ablation treatment at ≥ 31 gestational weeks (range 31.1-33.7 weeks). Bivariate analyses were used to compare outcomes.
Results:
Of 32 patients who underwent VP laser ablation during the study period, 14 (43.8%) had Type II and 18 (56.2%) had Type III VP. Preoperative characteristics (Table 1) and operative and perinatal outcomes (Table 2) were similar for VP Types. For Type II vs III, the mean (SD) gestational age (GA) at procedure was 32.0 ± 0.7 vs 32.0 ± 0.4 weeks, P=.731 and mean vessel distance to the os was 0.73 ± 0.65 vs 0.84 ± 0.62 cm, P=.893. The mean laser energy to achieve occlusion for Type II vs III was 7498 ± 5865 vs 4370 ± 2805 joules, P=.262. All patients had successful VP occlusion (1 required a second attempt) and all were managed as outpatients. The mean (SD) delivery GA was similar (36.7 ± 1.6 vs 37.0 ± 2.2 weeks, P=.608), and the vaginal delivery rates did not differ (71.4% vs 55.6%, P=.471). All patients had a live birth and survived at least 30 days. There were 2 cases requiring hyperbilirubinemia treatment, 1 for each Type, and 1 Type III case of respiratory distress syndrome (RDS). The neonatal intensive care unit length of stay (LOS) was 6.7 ± 3.1 (n=3) vs 26.8 ± 18.9 (n=4) days, P=.034; one outlier in the Type III group had a LOS of 53 days due to RDS. There were no cases of intraventricular hemorrhage, neonatal blood transfusion, or sepsis.
Conclusion:
Laser ablation treatment outcomes for Type II vs Type III VP were similar.