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Vasa previa screening

Objective: To perform a decision and cost-effectiveness analysis comparing four screening strategies for the antenatal diagnosis of vasa previa in singleton pregnancies. Methods: A decision-analytic model was constructed comparing vasa previa screening strategies. Published probabilities and costs were applied to four transvaginal screening scenarios that were carried out at the time of mid-trimester ultrasound: no screening, ultrasound-indicated screening, screening only pregnancies. This 'How To' article provides a practical approach for screening for vasa previa, including evaluation of the umbilical cord insertion site into the placenta, ensuring that there is no suspicion of a bilobed or succenturiate placenta, and re‐evaluating later in pregnancy the lower uterine segment carefully in all cases of resolving low‐lying placenta or placenta previa Screening women for vasa praevia during pregnancy is not recommended because: it is not known how many babies are affected by it in the UK; it is not known how accurate screening tests are at..

The findings of this study support the argument for revisiting the debate on the optimal method of screening for vasa previa, that is, the clinical and cost-effectiveness of screening for vasa previa in isolation using a risk factor-based approach or universally in tandem with cervical-length screening using transvaginal ultrasound, after taking into account the values and preferences of women who experienced pregnancies with vasa previa This study aimed to clarify ultrasound screening and management for vasa previa (VP) in perinatal centers and primary facilities in Japan. Methods A questionnaire survey about antepartum ultrasound screening and management for VP was delivered in 2018

Vasa praevia may be diagnosed during early labour by vaginal examination, detecting the pulsating fetal vessels inside the internal os, or by the presence of dark-red vaginal bleeding and acute fetal compromise after spontaneous or artificial rupture of the placental membranes Diagnosis and management of vasa previa Vasa previa occurs when unprotected fetal blood vessels run through the amniotic membranes and traverse the cervix. Complications include fetal hemorrhage, exsanguination, or death Vasa praevia is rightly referred to as an avoidable obstetric tragedy Today, as midwifery services continue to improve and local protocols evolve to reflect the latest research, it is more likely than ever that antenatal screening will be used to detect the presence of vasa praevia before the onset of catastrophic bleeding, hopefully saving the lives of many infants Symptoms of Vasa Previa Vasa previa does not always cause symptoms. When it does, the main symptom is the sudden onset of vaginal bleeding, especially in the second and third trimesters. It's especially worrisome if the blood is very dark or burgundy-colored, as it could indicate that the blood is coming from the fetus, not the mother. 5

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Vasa previa screening strategies: decision and cost

Screening for vasa previa was based on a two-stage strategy. In the first stage, a high-risk group was identified by, first, the presence of velamentous cord insertion at the inferior part of the placenta at the 11-13-week scan and, second, the presence of low-lying placenta at the 20-22-week scan RISK FACTORS, TESTING AND MANAGEMENT. Specific ultrasound screening is the key to diagnosing vasa previa. Risk Factors. Low-lying placenta or placenta previa in the second trimester (even if this resolves) Bilobed or succenturiate-lobed placenta ; Velamentous insertion of the cord ; In-vitro fertilization pregnancies ; Multiple-fetal pregnancie PDF | Aim: This study aimed to clarify ultrasound screening and management for vasa previa (VP) in perinatal centers and primary facilities in... | Find, read and cite all the research you need on. Universal transvaginal screening for vasa praevia in singleton pregnancies costs $579,164 per QALY compared with targeted screening. CONCLUSIONS: Compared with current practice, screening all twin pregnancies for vasa praevia with transvaginal ultrasound is cost-effective Ultrasound-indicated screening was defined as performing transvaginal ultrasound at the time of the routine anatomy ultrasound scan in response to one of the following sonographic findings associated with an increased risk of vasa previa: low-lying placenta, marginal or velamentous cord insertion or bilobed or succenturiate lobed placenta

How to screen for vasa previa - International Society of

Screening for vasa previa using transvaginal sonography with color flow mapping was performed routinely in the following situations: resolved placenta previa, prior pregnancy with vasa previa. Rebarber and colleagues performed targeted screening on 27,573 pregnancies and found 31 cases of vasa previa, giving an incidence of 1.1/1000 pregnancies Reference Rebarber, Dolin, Fox, Klauser, Saltzman and Roman 6. Retrospective studies of vasa previa based on diagnosis codes may also be flawed since the International Classification of Diseases (ICD-9) code for vasa previa is the same as that of velamentous cord insertion (762.6), creating further discrepancy in the reported incidence of. The cost‐effectiveness of targeted or universal screening for vasa praevia at 18-20 weeks of gestation in Ontari

What is Vasa Previa? | Vasa Previa Definition & Management

Vasa praevia - UK National Screening Committee (UK NSC

Video: Vasa previa and associated risk factors: a systematic

Objectives—To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa. Methods—A retrospective descriptive study of all cases of vasa previa from a single maternal-fetal medicine service between 2009 and 2017 was performed. Vasa previa is a very serious complication of pregnancy. It is natural to feel worried if your doctor has told you that you have vasa previa. The good news is that standard ultrasounds in the second trimester are often able to detect vasa previa or risk factors that make vasa previa more likely

Ultrasound screening and management of vasa previa in

  1. Vasa previa is a fetal hemorrhage caused by the rupture of fetal vessels in a velamentous insertion of the umbilical cord (type I vasa previa) or of vessels traversing the membranes between two lobes of the placenta (type II vasa previa). 1 Although this condition is rare, rapid diagnosis is crucial because fetal mortality is greater than 50%. If initial FHR tracings are nonreassuring, an.
  2. Vasa previa usually occurs in association with velamentous cord insertion, bipartite placenta, or succenturiate lobe, where vessels run through the membranes to join the separate lobes. Risk factors are multiple pregnancies, IVF conceptions (1 in 300) and low lying placenta in the second trimester. Investigations
  3. Pathogenesis. The 2 main causes of vasa previa are velamentous insertions (where the cord inserts directly into the membranes, leaving unprotected vessels running to the placenta) (25-62%) and vessels crossing between lobes of the placenta such as in succenturiate or bilobate placentas (33-75%) (36, 56).Less commonly, a vessel that courses over the edge of a marginal placenta or a placenta.
  4. AIM: This study aimed to clarify ultrasound screening and management for vasa previa (VP) in perinatal centers and primary facilities in Japan. METHODS: A questionnaire survey about antepartum ultrasound screening and management for VP was delivered in 2018. Questions were sent by email or post to perinatal centers and randomly selected primary.
  5. Vasa Praevia and Placenta Praevia Screening - Update 2008-2012 This review updates a previous review of the literature on screening for vasa praevia and placenta praevia submitted to the National Screening Committee in November 2008. A literature search for vasa praevia publications was carried out covering the period January 2008

Vasa Praevia: Diagnosis and Management (Green-top

Vasa Praevia: a descriptive review of existing literature and the evolving role of ultrasound in prenatal screening Abstract Introduction: Literature addressing the feasibility of prenatal detection of vasa praevia during the mid-trimester morphology ultrasound scan is scarce, as is a lack of consensus about the appropriat Although ultrasound screening is possible, little is known of the natural history and epidemiology with little research having been done into the accuracy of a screening test in a general population. 6 Subsequently, the RCOG comment that introduction of a screening test for vasa praevia does not currently meet the criteria for a screening. Vasa praevia (VP) is an uncommon obstetric condition that has a perinatal mortality rate of approximately 60% if not prenatally detected and appropriately managed. 1 It occurs when exposed fetal vessels traverse the amniotic membranes between the baby's presenting part and the internal cervical os. 2 The term 'vasa praevia' is derived from.

If vasa previa is present, your doctor may recommend a Caesarian section (C-section) between 35 and 37 weeks' gestation. In a planned C-section, your surgeon will be able to adjust the type and placement of the incision according to where your placenta and your baby's blood vessels are UOG videoclip: How to screen for vasa previa. Bookmark this page. May 13, 2021 UOG Videos. New UOG Journal videoclip on the necessary steps in screening for vasa previa. Read the 'How To' article by Ranzini and Oyelese. Become a Journal member for full, uninterrupted access to UOG . Become a Journal member It is arguable whether universal screening should be advocated or would be cost-effective. 10 Currently, the most agreed on recommendation is a risk-based approach to ultrasound screening for vasa previa based on the identification of maternal and placental risk factors that have been reported to include placenta previa, low-lying placenta.

The findings of this study support the argument for revisiting the debate on the optimal method of screening for vasa previa, that is, the clinical and cost-effectiveness of screening for vasa previa in isolation using a risk factor-based approach or universally in tandem with cervical-length screening using transvaginal ultrasound, after. Recent studies explore the ability of ultrasound to detect vasa praevia prenatally in both the general and high-risk populations. Whilst there is no consensus on the 'best' screening strategy, the majority of authors note that targeted screening of the high-risk population is the most achievable and cost-effective strategy The treatment for vasa previa is a C-section to get the baby out before the amniotic sac ruptures. It is possible to screen for vasa previa before birth with the use of transvaginal Doppler ultrasound, which can be used to map out the blood vessels and to identify unusual arrangements of blood vessels.The fragile and unsupported blood vessels characteristic of vasa previa may also rupture.

Vasa praevia (also called vasa previa) affects between one in 2,000 and one in 6,000 pregnancies. (RCOG, 2011) . In most pregnancies, blood vessels from the umbilical cord insert directly into the placenta. With vasa praevia the baby's blood vessels run through the membranes covering the cervix. (NHS Choices, 2018 This is a multicenter retrospective study of women identified as having a vasa previa during pregnancy or at the time of delivery who delivered between January 1, 2000 and December 31, 2012 at participating centers. The primary objective of the study is to describe techniques utilized to screen for and diagnose vasa previa Vasa previa (VP) results from an anomaly of placentation which is defined as the presence of an aberrant fetal vessels running through the membranes screening for it difficult to assess as studies have been conducted in specialist centres and are mainly retrospective. A recent decision and cost-effectivenes Screening for vasa previa. Hub: Debate: Should we perform MRI in case of suspicion of abnormal placentation? Anne Elodie Millischer versus Eric Jauniaux . Hear from the experts - Abnormally invasive placenta and vasa previa. I am Prof. Laurent Salomon, Chair of the Scientific Committee Screening protocols: universal vs targeted Management . Definition & Historic Prevalence • Vasa previa is defined as fetal vessels that run through the membranes, over, or within 2cm, of the uterine cervix and under the fetal presenting part, unprotected by the placenta or umbilical cor

To assess the accuracy and effectiveness of routine screening for vasa previa, to describe our experience, and to assess factors that contribute to missed cases of vasa previa. Methods. A retrospective descriptive study of all cases of vasa previa from a single maternal-fetal medicine service between 2009 and 2017 was performed Vasa previa happens when those umbilical blood vessels run through the part of the amniotic sac above the cervix. Secondly, a bilobed or succenturiate placenta can cause vasa previa. The placenta can form into two or more separate lobes, becoming bilobed or multilobed. A smaller, accessory lobe called a succenturiate lobe can also form Screening for vasa previa 609 anemia due to presumed hemorrhage from rupture of cases of elective Cesarean section in the vasa previa the fetal vessels; one case had vaginal birth at 24.9 weeks group, regression analysis demonstrated that there and the other had emergency Cesarean section for was a linear relationship between serial cervical. Vasa previa occurs in 1/2500-1/5000 pregnancies and is associated with an increased risk of preterm birth and the associated complications of prematurity. There is a 97% survival rate when diagnosed by prenatal ultrasound and a 44% survival rate when the diagnosis is made intrapartum The high prevalence of known risk factors in cases of vasa previa identified in our study makes it difficult not to offer screening for vasa previa at the time of midtrimester anatomy ultrasound scan, which is routinely performed in most high-resource countries. Learn More - Primary Sources

Conclusions: The use of standardized screening for vasa previa based on focused criteria was found to be effective in diagnosing vasa previa, with a 100% survival rate. Vasa previa diagnosed. Microsoft Word - Vasa praevia (C-Obs 47) Author: cschmid Created Date: 11/26/2019 4:42:11 PM. Background. Vasa previa is a rare condition that is associated with a high rate of fetal or neonatal death when not diagnosed antenatally. The majority of available studies are either small, do not include antepartum data, limited to single institutions, or are biased by inclusion of patients from registries and online vasa previa support groups

Diagnosis and management of vasa previa - SMFM

  1. Download Citation | On Jan 1, 2019, Giancarlo Mari published Vasa Previa | Find, read and cite all the research you need on ResearchGat
  2. Vasa Previa is a r elatively commo n complication that patients should be aware of but should not cause excess concern as most cases resolve without complications. Whether you have been diagnosed with vasa previa or simply want to be as informed as possible through your pregnancy, the team at Maternal Fetal Medicine Specialists in New York can help answer any questions
  3. To estimate the cost-effectiveness of targeted and universal screening for vasa praevia at 18-20 weeks of gestation in singleton and twin pregnancies. Design Cost-utility analysis based on a decision-analytic model comparing relevant strategies and life-long outcomes for mother and infant(s)
  4. Francois K, Mayer S, Harris C, Perlow JH. Association of vasa previa at delivery with a history of second-trimester placenta previa. Obstetrical & Gynecological Survey 2004; 59:245. Zhang W, Geris S, Beta J, et al. Prevention of stillbirth: impact of two-stage screening for vasa previa. Ultrasound Obstet Gynecol 2020; 55:605

Screening for vasa previa using TVUL with Doppler should be performed if velamentous cord insertion in the lower half of the uterus, succenturiate/bilobed placenta, or low-lying placenta are found. B : Cervical scanning of multiple pregnancies should include Doppler t Risk-based screening is useful, as in 83% of cases one or more risk factors for vasa previa are present [26]. The most recent meta-analysis found associations between vasa previa and low-lying placenta (62%), velamentous cord insertion (52%), bilobed or succenturiate lobed placenta (33%), use of in vitro fertilization (26%), and multiple.

Understanding Vasa Praevia Ausme

The arguments have been that it is prohibitively expensive to screen for vasa previa using ultrasound and that it requires a reasonable degree of skill to make the diagnosis. As such, it is not currently the standard of care to look for vasa previa. Nevertheless, we have identified a second-trimester low-lying placenta as an important risk. Knowing about Vasa Praevia due to routine screening means. around 15 weeks of anxiety, around 5 weeks of hospitalisation, and a planned caesarean section at 35 weeks of pregnancy, with a possible short stint for the baby in special care. Babies born at around 35 weeks generally do very well

Vasa Previa Diagnosis and Treatment to Stop Stillbirt

Vasa previa screening strategies: decision and cost‐effectiveness analysis UOG Volume 52, Issue 4, Date: October 2018, Pages 244-249; First‐trimester screening for trisomies in pregnancies with vanishing twin UOG Volume 55, Issue 3, Date: March 2020, Pages 326-33 Placenta praevia is when the placenta lies too low in the womb (uterus) after 20 weeks of pregnancy. Read more about placenta praevia on the NHS website.. UK NSC screening recommendation Based on the last UK NSC review of this condition that occurred in December 2013 A Toronto couple whose baby daughter died during childbirth says doctors should make screening for vasa previa— a condition where the placenta lies low in the uterus— a common practice The Diagnosis of Vasa Previa is suspected by the presentation or by the results of routine prenatal ultrasound. At the exhibition, the fetal heart rate pattern, commonly sinusoidal, is usually non-reactive. The Diagnosis typically confirms by transvaginal ultrasound. The fetal vessels within the membranes can see passing directly over or near. For screening of the vasa previa, it is helpful to recognize the presence of placenta previa, low-lying placenta, and velamentous insertion of the umbilical cord [9]. Recognizing the site of the umbilical cord insertion early in pregnancy has been informative in diagnosing vasa previa [10]. Furthermore, in midpregnancy

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Tijdens het webinar behandelen we verschillende actuele onderwerpen op het gebied van de prenatale screening, zoals het toenemende belang van informatiebeveiliging, vasa previa en onderzoek over counseling. Ook zal er aandacht besteed worden aan nevenbevindingen bij de NIPT, en wat de uitkomsten zijn wanneer er sprake is van een nevenbevinding Prevention of stillbirths: impact of a two-stage screening for vasa previa. Ultrasound Obstet Gynecol. 2019 Dec 16;: Authors: Zhang W, Geris S, Beta J, Ramadan G, Nicolaides KH, Akolekar R Abstract OBJECTIVES: To examine the feasibility and effectiveness of a two-stage ultrasound screening strategy for detection of vasa previa and estimate the potential impact of screening on.. Managing Vasa Previa. There is no cure for vasa previa, but if it is properly managed, the baby's chances of survival are greatly increased. When vasa previa has been diagnosed, doctors should carefully monitor the mother and fetus, starting around the 28th to the 30th week, testing fetal well-being twice per week A diagnosis of vasa previa was confirmed by transvaginal color Doppler imaging. Results We encountered 10 cases of vasa previa among 5131 deliveries. All cases had one or more known risk factors. In all of the four cases that underwent screening in the second trimester (i.e. between 20 and 25 weeks of gestation), the diagnosis was correct Vasa previa is an extremely rare but devastating condition in which fetal umbilical cord blood vessels cross or run in close proximity to the inner cervical os (the internal opening in the cervix separating the uterine cavity from the vagina). These vessels course within the membranes, unsupported by the umbilical cord or placental tissue, and are at risk of rupture if the supporting membranes.

Prenatal diagnosis of vasa previa through color doppler and three-dimensional power doppler ultrasonography. A case report. Clinical and experimental obstetrics & gynecology 33 (2): 122-124. Arts, H., and J. v. Eyck. 1993. Antenatal diagnosis of vasa previa by transvaginal color doppler sonography Csection in vasa previa: 34-35 weeks, GDM screening by GCT in low risks: 24-28 weeks, Dinoprostone should not be used if the patient has any other condition contraindicating a vaginal delivery such as vasa previa or genital herpes infection. Vasa praevia. Missing: usml Vasa Previa. Vasa previa occurs when membranes that contain fetal blood vessels connecting the umbilical cord and placenta overlie or are within 2 cm of the internal cervical os. Vasa previa can occur on its own (see figure Vasa previa) or with placental abnormalities, such as a velamentous cord insertion. In velamentous cord insertion, vessels.

1. BJOG. 2017 Jan;124(1):162. doi: 10.1111/1471-0528.14013. Re: Incidence of and risk factors for vasa praevia: a systematic review: Vasa praevia screening CONCLUSION: Vasa previa affects 0.46 cases per 1000 pregnancies. Given the high prevalence of prenatally detectable risk factors in affected pregnancies, the cost-effectiveness of screening strategies for vasa previa either in isolation, using a risk factorebased approach, or universally, in tandem with cervical-length screening usin (This study evaluated prospective screening for vasa previa using color Doppler ultrasound. 33,208 women were screened, and 11 cases of vasa previa were diagnosed. There was one false positive.

Prevention of stillbirth: impact of two‐stage screening

Prenatal management of vasa previa is controversial, partly because randomized clinical trials are lacking. At most centers, nonstress testing is done twice a week beginning at 28 to 30 weeks. The purpose is to detect compression of the umbilical cord A diagnosis of vasa previa was confirmed by transvaginal color Doppler imaging. RESULTS: We encountered 10 cases of vasa previa among 5131 deliveries. All cases had one or more known risk factors. In all of the four cases that underwent screening in the second trimester (i.e. between 20 and 25 weeks of gestation), the diagnosis was correct The bases for this question are: ( 1) Vasa previa is known to be a tare but catastrophic obstetric compli­cation that theoretically can be screened for by testing for fetal hemorrhage. (2) Recently a malpractice case has occurred wherein the plaintiff's allegation was fail­ure to test for and diagnose vasa previa, with a poor outcome

IVPF Recommendations - Vasa Previ

  1. There are no strategies for primary prevention of vasa previa; however, hemorrhage theoretically is preventable with antenatal screening for women at high risk and cesarean delivery at 37 to 38.
  2. Monochorionic diamniotic twins and vasa previa are uncommon. We present a case that was followed from ultrasound diagnosis to delivery. 1. Introduction Vasa previa is a vascular pathology of the.
  3. About Vasa Praevia raising awareness. The UK registered charity was set up because every year in the UK, this obstetric condition will affect approximately 555 pregnancies (more than one per day). In the main these cases will go undiagnosed until birth and sadly, likely to result in the death of an otherwise healthy baby
  4. A universal screening method for the detection of vasa previa has not yet been established although high-risk factors have been identified . Baulies et al. reported that the incidence of vasa previa was 0.07%, and multivariate analysis revealed the following associated factors in their study
  5. A positive test would indicate that blood is of fetal origin, and could be due to vasa previa. A negative test indicates that the blood is of maternal origin. In practice, the Apt test may not be done when there is suspicion of vasa previa, because the time to fetal collapse with bleeding from vasa previa is often very short
  6. Vasa praevia is a real nightmare for obstetricians if not diagnosed prenatally. We report five cases of vasa praevia with different presentations and outcomes. In the first case, vasa praevia was not diagnosed during the antenatal period and the baby was stillborn due to ruptured fetal vessels. In the other four cases, vasa praevia was diagnosed in antenatal period and all the cases had good.

In pregnancies with coexistent vasa previa, we perform nonstress testing to look for any evidence of cord compression. (See Velamentous umbilical cord insertion and vasa previa, section on 'Management'.) Autologous blood donation — Some patients may consider autologous blood donation,. A: The goal of management of vasa previa is to safely prolong pregnancy while avoiding potential complications and mortality related to rupture of membranes (ROM) or labor. Because vasa previa is rare, recommendations regarding management are based on observational data, decision analyses, and expert opinion In the same study, however, in twin pregnancies, universal screening for vasa previa with transvaginal ultrasound was shown to be cost-effective. 15 Detection of vasa previa by transvaginal ultrasound earlier than the second trimester has been explored by looking for the cord insertion site in the first trimester Vasa praevia (VP) is a rare phenomenon that is assumed to increase the risk of severe complications, including fetal death. Critical data on its incidence are lacking, so there is no rational basis for prenatal screening Discussion. Vasa previa is a rare obstetrical catastrophe with a reported incidence ranging from 1 in 1275 to 1 in 8333.1,2 The diagnosis is often not made antepartum. Patients usually present with bleeding at the time of spontaneous or artificial rupture of membranes.2 However, bleeding can occur before rupture of membranes.7 Vasa previa can also present with fetal bradycardia when the.

(PDF) Ultrasound screening and management of vasa previa

The cost-effectiveness of targeted or universal screening

Discussion. Ruptured vasa previa is a serious and often fatal (to the fetus) obstetric emergency, which was first described in 1801 by Lobstein. 1 Before the advent of ultrasound imaging, vasa previa was solely a clinical diagnosis consisting of a triad of ruptured membranes, painless vaginal bleeding (fetal bleeding), and fetal distress or demise. In obstetric terms, vasa previa is defined as. Placenta previa and vasa previa are usually diagnosed as part of routine screening on a midtrimester ultrasound, and digital exams in these women must be avoided. All of these conditions can lead to maternal and/or fetal hemorrhage, necessitating emergency C-section and maternal and/or fetal resuscitation At SDPC, we routinely screen patients for vasa previa with transvaginal ultrasound because the risk for fetal exsanguination can be averted by early cesarean delivery. Vasa previa is thought to occur in about 1 in every 2000 pregnancies. It is more common in multiple gestations and in IVF pregnancies. Vasa previa is seen more commonly. 115 screening op vasa previa onder vrouwen zonder enige risicofactor. 116 117 Uit meerdere studies is gebleken dat vrouwen met vasa previa in circa 85% van de gevallen één of 118 meerdere risicofactoren hadden.2,16 Uit een kosteneffectiviteitsanalyse van Cipriano uit 2010 i Vasa Previa Screening op predisponerende factoren Geplaatst op 20 oktober 2008. Vasa previa staat bekend als een zeldzame maar ernstige complicatie. Het stellen van de diagnose vindt vaak pas bij het optreden van ruim vaginaal bloedverlies of postpartum plaats

Vasa Previa: The Case for Routine Screening Request PD

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Screening, diagnostiek en beleid bij vasa previa - concept richtlijn 57 CAPTR 4 Tabel 1. Risicofactoren voor vasa previa met numbers needed tot screen Risicofactor Number needed to screen Velamenteuze insertie 13 Placenta bilobata / succenturiata 37 Placenta previa 63 Zwanger na IVF of ICSI 260 Zwangere in algemene populatie 166 In addition, there is a case for routine screening for Vasa Praevia especially since the condition, though rare, is catastrophic.) Professor Dr. Yves Ville Université Paris-Quest, CHR Poissy-St Germain, Dept of Gynaecology and Obstetrics, 10 rue du Champ-Gaillard, 78303 Poissy Cedex, France. email: yviIle@wanadoo.f

Questo studio retrospettivo valuta l'accuratezza e l'efficacia delle proiezioni di ultrasuoni prenatali di routine (US) per vasa previa. (855) 873-7666 Accedi Il Tuo Carrell

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