Research Questionnaire

As part of our goal to increase awareness of vasa previa amongst the medical community worldwide, the IVPF participates in studies which yield important information about vasa previa.

You have been affected by vasa previa and understand, better than anyone else, the devastating impact of the loss of a much awaited and beloved otherwise healthy child to vasa previa. Our goal is to prevent more babies being lost to this terrible complication of pregnancy. This can only be achieved by raising awareness of the different ways the condition presents, of associated risk factors, diagnostic modalities, treatment and outcomes.

However, to achieve this goal, we need your help. If you have not already done so, please help us by filling in the following questionnaire about your experience with vasa previa.

By completing this form you provide your consent for the data entered to be used for research into vasa previa. Only de-identified data will ever be used, your name will be kept confidential and will not be used in any study. We are counting on you to help us reduce the incidence of these preventable deaths.

Thank you for all of your help.

The IVPF Research Committee

What is your email address (always kept private)?
Do you consent for this information (excluding names) to be used for research purposes?

What was your age at time of your vasa previa pregnancy?  
Was this a multiple pregnancy?

Was this your first pregnancy?

Did you have a placental abnormality at any time during your pregnancy?
Did you have a low lying placenta during second trimester?

Did you bleed at any time during your pregnancy?

Were you hospitalized during your pregnancy? Yes at weeks gestation.    No
Did you undergo artificial reproductive technology (ART) such as in-vitro fertilization (IVF)?

How was your vasa previa diagnosed?
At what week were you diagnosed?
Was amniocentesis performed for lung maturity prior to delivery?

Were steroids given for fetal lung maturity?

Are you a smoker?

Please describe the type of vasa previa you had?
Do you have pictures or sonographic (ultrasound) reports?
Did your vasa previa baby survive?

What was the gestational age at delivery?
What is the full name of your vasa previa child?      
What is the child's birthdate?  
What is the mother's name?    
What is the father's name?    
What was the apgar rating at 1 minute?
What was the apgar rating at 5 minutes?
Was a neonatal transfusion performed?

Was your delivery vaginal or cesarean?
Please provide any additional information below: