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The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods

The objective of this exploratory modelling study was to estimate the effects of second-trimester, ultrasound-based antenatal detection strategies for vasa praevia (VP) in a hypothetical cohort of pregnant women. For this, a decision-analytic tree model was developed covering four discrete detection...

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Autores principales: Ruban-Fell, Benjamin, Attilakos, George, Haskins-Coulter, Tao, Hyde, Christopher, Kusel, Jeanette, Mackie, Anne, Rivero-Arias, Oliver, Thilaganathan, Basky, Thomson, Nigel, Visintin, Cristina, Marshall, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767376/
https://www.ncbi.nlm.nih.gov/pubmed/36538562
http://dx.doi.org/10.1371/journal.pone.0279229
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author Ruban-Fell, Benjamin
Attilakos, George
Haskins-Coulter, Tao
Hyde, Christopher
Kusel, Jeanette
Mackie, Anne
Rivero-Arias, Oliver
Thilaganathan, Basky
Thomson, Nigel
Visintin, Cristina
Marshall, John
author_facet Ruban-Fell, Benjamin
Attilakos, George
Haskins-Coulter, Tao
Hyde, Christopher
Kusel, Jeanette
Mackie, Anne
Rivero-Arias, Oliver
Thilaganathan, Basky
Thomson, Nigel
Visintin, Cristina
Marshall, John
author_sort Ruban-Fell, Benjamin
collection PubMed
description The objective of this exploratory modelling study was to estimate the effects of second-trimester, ultrasound-based antenatal detection strategies for vasa praevia (VP) in a hypothetical cohort of pregnant women. For this, a decision-analytic tree model was developed covering four discrete detection pathways/strategies: no screening; screening targeted at women undergoing in-vitro fertilisation (IVF); screening targeted at women with low-lying placentas (LLP); screening targeted at women with velamentous cord insertion (VCI) or a bilobed or succenturiate (BL/S) placenta. Main outcome measures were the number of referrals to transvaginal sonography (TVS), diagnosed and undiagnosed cases of VP, overdetected cases of VCI, and VP-associated perinatal mortality. The greatest number of referrals to TVS occurred in the LLP-based (2,083) and VCI-based screening (1,319) pathways. These two pathways also led to the highest proportions of pregnancies diagnosed with VP (VCI-based screening: 552 [78.9% of all pregnancies]; LLP-based: 371 [53.5%]) and the lowest proportions of VP leading to perinatal death (VCI-based screening: 100 [14.2%]; LLP-based: 196 [28.0%]). In contrast, the IVF-based pathway resulted in 66 TVS referrals, 50 VP diagnoses (7.1% of all VP pregnancies), and 368 (52.6%) VP-associated perinatal deaths which was comparable to the no screening pathway (380 [54.3%]). The VCI-based pathway resulted in the greatest detection of VCI (14,238 [99.1%]), followed by the IVF-based pathway (443 [3.1%]); no VCI detection occurred in the LLP-based or no screening pathways. In conclusion, the model results suggest that a targeted LLP-based approach could detect a substantial proportion of VP cases, while avoiding VCI overdetection and requiring minimal changes to current clinical practice. High-quality data is required to explore the clinical and cost-effectiveness of this and other detection strategies further. This is necessary to provide a robust basis for future discussion about routine screening for VP.
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spelling pubmed-97673762022-12-21 The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods Ruban-Fell, Benjamin Attilakos, George Haskins-Coulter, Tao Hyde, Christopher Kusel, Jeanette Mackie, Anne Rivero-Arias, Oliver Thilaganathan, Basky Thomson, Nigel Visintin, Cristina Marshall, John PLoS One Research Article The objective of this exploratory modelling study was to estimate the effects of second-trimester, ultrasound-based antenatal detection strategies for vasa praevia (VP) in a hypothetical cohort of pregnant women. For this, a decision-analytic tree model was developed covering four discrete detection pathways/strategies: no screening; screening targeted at women undergoing in-vitro fertilisation (IVF); screening targeted at women with low-lying placentas (LLP); screening targeted at women with velamentous cord insertion (VCI) or a bilobed or succenturiate (BL/S) placenta. Main outcome measures were the number of referrals to transvaginal sonography (TVS), diagnosed and undiagnosed cases of VP, overdetected cases of VCI, and VP-associated perinatal mortality. The greatest number of referrals to TVS occurred in the LLP-based (2,083) and VCI-based screening (1,319) pathways. These two pathways also led to the highest proportions of pregnancies diagnosed with VP (VCI-based screening: 552 [78.9% of all pregnancies]; LLP-based: 371 [53.5%]) and the lowest proportions of VP leading to perinatal death (VCI-based screening: 100 [14.2%]; LLP-based: 196 [28.0%]). In contrast, the IVF-based pathway resulted in 66 TVS referrals, 50 VP diagnoses (7.1% of all VP pregnancies), and 368 (52.6%) VP-associated perinatal deaths which was comparable to the no screening pathway (380 [54.3%]). The VCI-based pathway resulted in the greatest detection of VCI (14,238 [99.1%]), followed by the IVF-based pathway (443 [3.1%]); no VCI detection occurred in the LLP-based or no screening pathways. In conclusion, the model results suggest that a targeted LLP-based approach could detect a substantial proportion of VP cases, while avoiding VCI overdetection and requiring minimal changes to current clinical practice. High-quality data is required to explore the clinical and cost-effectiveness of this and other detection strategies further. This is necessary to provide a robust basis for future discussion about routine screening for VP. Public Library of Science 2022-12-20 /pmc/articles/PMC9767376/ /pubmed/36538562 http://dx.doi.org/10.1371/journal.pone.0279229 Text en © 2022 Ruban-Fell et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Ruban-Fell, Benjamin
Attilakos, George
Haskins-Coulter, Tao
Hyde, Christopher
Kusel, Jeanette
Mackie, Anne
Rivero-Arias, Oliver
Thilaganathan, Basky
Thomson, Nigel
Visintin, Cristina
Marshall, John
The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods
title The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods
title_full The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods
title_fullStr The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods
title_full_unstemmed The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods
title_short The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods
title_sort impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the united kingdom: an exploratory study using decision analytic modelling methods
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9767376/
https://www.ncbi.nlm.nih.gov/pubmed/36538562
http://dx.doi.org/10.1371/journal.pone.0279229
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