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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

Author

Listed:
  • Benjamin Ruban-Fell
  • George Attilakos
  • Tao Haskins-Coulter
  • Christopher Hyde
  • Jeanette Kusel
  • Anne Mackie
  • Oliver Rivero-Arias
  • Basky Thilaganathan
  • Nigel Thomson
  • Cristina Visintin
  • John Marshall

Abstract

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.

Suggested Citation

  • Benjamin Ruban-Fell & George Attilakos & Tao Haskins-Coulter & Christopher Hyde & Jeanette Kusel & Anne Mackie & Oliver Rivero-Arias & Basky Thilaganathan & Nigel Thomson & Cristina Visintin & John Ma, 2022. "The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods," PLOS ONE, Public Library of Science, vol. 17(12), pages 1-18, December.
    • Handle: RePEc:plo:pone00:0279229
    DOI: 10.1371/journal.pone.0279229
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    1. Gray, Alastair M. & Clarke, Philip M. & Wolstenholme, Jane L. & Wordsworth, Sarah, 2010. "Applied Methods of Cost-effectiveness Analysis in Healthcare," OUP Catalogue, Oxford University Press, number 9780199227280, Decembrie.
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