Fetoscopic ablation shown to reduce prematurity risks in vasa previa

Ramesh Papanna, MD, MPH, (left) and Sami Backley, MD, (right) are co-authors on the study. (Photo by UTHealth Houston)

A study by researchers at UTHealth Houston concluded that fetoscopic ablation is an alternative treatment for select cases of vasa previa.

The findings were published in Ultrasound in Obstetrics & Gynecology. 

In women diagnosed with vasa previa, blood vessels run near the cervix without protection from the umbilical cord or placenta. If it is not detected or managed properly, vasa previa can result in severe bleeding or stillbirth. Fetoscopic ablation offers an alternative to hospital admission in late pregnancy and cesarean delivery by sealing off the blood flow, leaving the entire placenta untouched.

Ramesh Papanna, MD, MPH, serves as professor and director of the Fetal Intervention Fellowship at McGovern Medical School at UTHealth Houston, as well as co-director of the UTHealth Houston Fetal Center. He co-authored the four-year study comparing fetoscopic laser ablation with standard management for Type II and Type III vasa previa at two major U.S. referral centers. To date, Papanna and his team have performed 30 cases.

“Our findings show that fetoscopic laser ablation benefits both mother and baby by reducing the risk of prematurity and shortening NICU stays,” said Papanna,  senior author on the study. “This minimally invasive approach also increases the likelihood that women can carry their pregnancies longer and closer to full-term.”

They found that 60% of the women in the study were able to deliver vaginally with fetoscopic laser ablation compared to the traditional form of treatment. 

“This procedure represents a major step forward in providing an alternative to long hospital stays and pre-labor cesarean deliveries for women with vasa previa,” said Sami Backley, MD, first author on the study and assistant professor in the Division of Fetal Intervention in the Department of Obstetrics, Gynecology, and Reproductive Sciences at McGovern Medical School. “The ability to offer a fetal intervention has promising benefits for mom and baby and has the potential to change the standards of care for vasa previa.”   

Backley added that fetoscopic ablation can shorten both maternal hospital stays and NICU stays while reducing the risk of prematurity and neonatal transfusions. The procedure may also allow for outpatient care and increase the likelihood of vaginal delivery.

Applying fetoscopic ablation to vasa previa is innovative because it adapts a well-established laser technique, used for decades in other medical procedures, to safely address exposed fetal blood vessels in this high-risk condition, offering a minimally invasive alternative to traditional management.  

“While not a mainstay treatment for vasa previa, we believe our research unlocks potential for it to eventually become a standard of care,” Papanna said.