OC03.03: *Comparison of standard management versus fetoscopic laser ablation for types II and III vasa previa

The standard management (SM) of vasa previa (VP) includes inpatient admission at 28-32 weeks gestation (GA) followed by Caesarean delivery at 34-37 weeks GA. The aim of our study was to compare maternal and neonatal outcomes in patients with Type II/III vasa previa who underwent fetoscopic laser ablation (FLA) with those receiving SM. This was a cohort study of all antenatally diagnosed cases of VP type II and III identified by ultrasound between September 2016-December 2023 from two centres. Patients undergoing elective FLA were prospectively followed in both centres, and the SM were selected retrospectively from a single centre. The primary outcome was the success rate of vaginal delivery. Secondary outcomes are included in table 1. Comparative analysis was performed between SM and FLA groups with VP type II/III. There were 67 singleton pregnancies complicated by Type II/III VP of which 35/67 (52.2%) underwent FLA. There were no differences in baseline demographics between both groups. Vaginal delivery was significantly higher in the FLA group (63% compared to 0%). Maternal antenatal hospital stay was 11 days shorter in the FLA group. The need for neonatal blood transfusion was significantly lower in the FLA cohort (p = 0.004). FLA for vasa previa types II and III allows for vaginal delivery with improved neonatal outcomes. Standard management (SM) N (%) = 321 Fetoscopic laser ablation (FLA) N (%) = 351