The following is a summary of “Third-trimester fetoscopic ablation therapy for types II and III vasa previa,” published in the January 2024 issue of Obstetrics and Gynecology by Chmait, et al.

Vasa previa is a rare obstetric condition characterized by fetal vessels crossing the fetal membranes near the cervix without the protection of the placenta. Types of vasa previa include Type I, which stems from a velamentous cord root, and Types II and III, which arise from an accessory or distal lobe of the placenta, respectively. Fetoscopic laser ablation has emerged as a novel therapeutic option for Types II and III vasa previa, offering benefits such as surgical resolution, shortened hospitalization, and the potential for term vaginal delivery. By delaying laser surgery until 31 to 33 weeks of gestation, potential risks can be minimized, allowing for immediate post-procedural surveillance. For a study, researchers sought to evaluate the feasibility and outcomes of fetoscopic laser ablation in the third trimester for patients with Types II and III vasa previa.

A retrospective analysis was conducted on singleton pregnancies with Types II and III vasa previa treated with fetoscopic laser ablation at a single center between 2006 and 2022. Pregnancy and newborn outcomes were assessed, with continuous variables presented as mean ± standard deviation.

Out of 84 patients referred for vasa previa, 20 underwent fetoscopic laser ablation after meeting the inclusion criteria. The mean gestational age at the time of the procedure was 32.0 ± 0.6 weeks, with a total operative time of 62.1 ± 19.6 minutes. No perioperative complications were reported, and all patients achieved successful occlusion of the vasa previa vessels, with one requiring a second procedure. Subsequent outpatient management was successful, with a mean gestational age at delivery of 37.2 ± 1.8 weeks and a mean birthweight of 2,795 ± 465 g. Vaginal delivery was achieved in 70% of cases, and neonatal intensive care unit admission was required for three cases, primarily for respiratory distress syndrome and hyperbilirubinemia requiring phototherapy. No cases of neonatal transfusion, intraventricular hemorrhage, sepsis, patent ductus arteriosus, or death were reported.

Fetoscopic laser ablation for Types II and III vasa previa performed at 31 to 33 weeks of gestation was technically feasible and associated with favorable maternal and neonatal outcomes.

Reference: ajog.org/article/S0002-9378(23)00621-X/abstract