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

被引:7
作者
Ruban-Fell, Benjamin [1 ]
Attilakos, George [2 ]
Haskins-Coulter, Tao [1 ]
Hyde, Christopher [3 ]
Kusel, Jeanette [1 ]
Mackie, Anne [4 ]
Rivero-Arias, Oliver [5 ]
Thilaganathan, Basky [6 ,7 ]
Thomson, Nigel [8 ]
Visintin, Cristina [9 ]
Marshall, John [9 ]
机构
[1] Costello Med, London, England
[2] Univ Coll London Hosp, Fetal Med Unit, London, England
[3] Univ Exeter, Coll Med & Hlth, Inst Hlth Res, Exeter Test Grp, St Lukes Campus, Exeter, Devon, England
[4] Publ Hlth England, Natl Screening Comm, London, England
[5] Univ Oxford, Nuffield Dept Populat Hlth, Natl Perinatal Epidemiol Unit, Oxford, England
[6] St Georges Univ London, Fetal Med Unit, St Georges Univ Hosp NHS Fdn Trust, London, England
[7] St Georges Univ London, Mol & Clin Sci Res Inst, London, England
[8] Soc & Coll Radiographers, London, England
[9] UK Natl Screening Comm, London, England
关键词
DIAGNOSIS; MANAGEMENT; GUIDELINES; TOOL; UK;
D O I
10.1371/journal.pone.0279229
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
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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页数:18
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