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(BJOG. 2016;123:1278–1287)Vasa previa (VP) is a rare but serious condition of fetal blood vessels lying over the cervical os. As the presenting part descends, the vessels can be compressed leading to fetal heart rate abnormalities. There is also the potential for rupture of the vessels and fetal hemorrhage with rupture of membranes. Thus, there is increased risk for neonatal morbidity or mortality in the setting of VP. Prenatal identification of VP via ultrasound could prevent neonatal death and morbidity by prompting elective cesarean delivery, thereby avoiding rupture of the fetal vessels. However, ultrasound examination of the umbilical cord insertion site is not routine. This meta-analysis was undertaken to determine the occurrence and risk indicators of VP with the goal of identifying the at-risk population that should receive ultrasound screening.