(1197) Vasa Previa: Factors associated with Inpatient vs. Outpatient Antepartum Management

Objective: When vasa previa is diagnosed, guidelines support recommendations about timing and route of delivery, as well as steroid administration. While elective admission to ensure proximity to care is common, evidence does not support a clear recommendation. Our objective was to compare patients with vasa previa managed as inpatients vs outpatients.

Study Design: This is a single institution cohort study of patients with a prenatal diagnosis of vasa previa from 2013-2023. Cases resolved in the third trimester were excluded. Decisions about inpatient vs. outpatient management and timing of planned delivery were made by physicians and patients. Demographic factors and outcomes were obtained through chart review. Cohorts managed with elective admission for the indication of vasa previa were compared with those managed as outpatients. Mann-Whitney U and Fisher's Exact test were used for statistical comparison.

Results: 89 patients were included, including 72 (80.9%) electively admitted vs. 17 (19.1%) managed as outpatients. The cohorts are compared in Table 1. The groups were of similar age and parity. A higher proportion of patients managed as outpatients had public insurance. There were no differences in the rate of a short cervical length or antepartum vaginal bleeding between the cohorts, and the rates of non-scheduled Cesarean Delivery were similar. Betamethasone was administered at a median gestational age of 32-33 weeks in both groups. Elective admission was associated with earlier gestational age at delivery overall, as well as earlier scheduled delivery. There were no stillbirths or neonatal deaths, and the rates of NICU admission were not significantly different between the groups.

Conclusion: Patients electively admitted for vasa previa do not appear to have been at higher risk for emergent delivery, though admission was associated with earlier delivery, including scheduled deliveries. The lower rate of admission in those with Medicaid could indicate a disparity in management, though further study is necessary. While our data do not rule out a benefit to routine admission, the benefits remain unproven.