Fetoscopic laser ablation vs standard management for Type-II and Type-III vasa previa.

objectiveThe standard management (SM) for vasa previa (VP) includes antepartum inpatient admission at 28-32 weeks' gestation followed by Cesarean delivery at 34-37 weeks. Case reports and case series have reported on fetoscopic laser ablation (FLA) as an alternative management approach for Types-II and -III VP. This study compared maternal and neonatal outcomes in patients with Type-II or -III VP who underwent third-trimester FLA with those who underwent SM.

methodsThis was a cohort study of all antenatally diagnosed cases of Type-II or -III VP identified by ultrasound at, or referred to, two large referral centers in the USA between September 2016 and December 2023. Patients undergoing elective FLA were prospectively followed in both centers, while patients in the SM cohort were selected retrospectively from a single center. The primary outcome was gestational age at delivery. Comparative analysis was performed between SM and FLA cohorts.

resultsThere were 67 singleton pregnancies complicated by Type-II or -III VP, of which 35 (52.2%) underwent FLA. There were no differences in baseline demographics between the two cohorts. The median gestational age at delivery was 36.0 (interquartile range (IQR), 35.0-37.6) weeks in the FLA cohort and 34.4 (IQR, 33.4-35.0) weeks in the SM cohort (P < 0.001). The rate of vaginal delivery in the FLA cohort was 62.9%. Individuals who underwent FLA had a shorter maternal antepartum stay than did those with SM (median, 1 (IQR, 0-3) days vs 16 (IQR, 7-23) days; P < 0.001). The probability of preterm delivery was higher with SM than with FLA (hazard ratio, 0.24 (95% CI, 0.14-0.44)). The need for neonatal blood transfusion was lower in the FLA cohort than in the SM cohort (0% vs 18.8%; P = 0.009).

conclusionsThird-trimester FLA offers an alternative to SM for pregnancies complicated by Type-II or -III VP, as it is associated with delivery at a later gestational age and facilitates the option of vaginal delivery. Further research is needed to assess the efficacy of FLA and to provide adequate power to evaluate the potential benefits for both maternal and neonatal outcomes. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.