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Vasa Praevia: Diagnosis and Management

Vasa praevia is a rare condition where fetal blood vessels run in the membranes below the presenting fetal part instead of within the placenta, putting the fetus at risk of exsanguination if the membranes rupture. The risk of fetal mortality is 33-100% if not diagnosed prenatally. It can be diagnosed as early as 16 weeks gestation via ultrasound screening of the low-lying placenta and cord insertion. Planned cesarean section is recommended for delivery if diagnosed to avoid the risks of vaginal bleeding from ruptured vessels.

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441 views14 pages

Vasa Praevia: Diagnosis and Management

Vasa praevia is a rare condition where fetal blood vessels run in the membranes below the presenting fetal part instead of within the placenta, putting the fetus at risk of exsanguination if the membranes rupture. The risk of fetal mortality is 33-100% if not diagnosed prenatally. It can be diagnosed as early as 16 weeks gestation via ultrasound screening of the low-lying placenta and cord insertion. Planned cesarean section is recommended for delivery if diagnosed to avoid the risks of vaginal bleeding from ruptured vessels.

Uploaded by

khadzx
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd

Vasa Praevia

Dr Fatima Z Ashrafi
DGO (Dub), FRCS (Edin), MRCOG (Lon),
FRANZCOG
Gisborne Hospital, New Zealand
Vasa Praevia
■ Rare - 1 in 3000
■ Fetal vessels run in the membrane below the
presenting fetal part, unsupported by placental tissue
or umbilical cord
■ Spontaneous or artificial rupture of membranes -
rupture these vessels - fetal exsanguination.
■ Hypoxia if the vessels are compressed between
baby & birth canal.
■ Fetal mortality 33-100%, if not diagnosed prenatally.
Pathology
■ Unknown cause.
■ Trophotropism - tendency of a plant to lean towards
sun to get light to survive. Lower segment not
nourishing - placenta grows upwards to reach more
nourishing tissue.
■ Risk factors

Low lining placenta


bilobed or succenturiate placenta
Velamentous insertion of cord
Multple pregnancies
IVF pregnancies
Velamentous insertion of cord
■ 1% - singleton pregnancies, 8.7% - twin
pregnancies, higher in early pregnancy &
spontaneous abortion.
■ Umbilical cord usually inserts on placental mass -
99% cases.
■ Velamentous - cord inserted on chorioamniotic
membrane.
■ Variable amount of cord unprotected by Wharton’s
jelly.
■ Vasa praevia coexisting in 6% singleton pregnancies
with velamentous insertion.
Velamentous insertion of cord
Twin Placenta with a succenturiate lobe
Circumvallate Placenta.
Symptoms
■ Asymptomatic

■ sudden onset of painless bleeding in 2nd or 3rd


trimester or at ARM/SRM.

■ Heavy or small amount of bleeding. No sign symptom


of Placenta praevia or abruption.

■ IUGR/ Congenital malformation

■ Maternal risk: bleeding


Antenatal Diagnosis
■ An avoidable tragedy.
■ Changing ultrasound protocol for checking placental
cord connection.
■ Can be diagnosed as early as 16 weeks .
■ All suspected cases should be checked for vasa
praevia
■ Level 2 scan of LUS and/or transvaginal scan with
color doppler.
Doppler scan to detect Vasa praevia - 1
Doppler scan to detect Vasa praevia - 2
Management
■ If diagnosed prenatally
tocolytics,
bedrest
no vaginal exams
avoid heavy lifting, straining during bowel movement
regular scans
■ Planned cesarean section can circumvent fetal risks.

■ Delivery can be planned early enough to avoid


emergency, but late enough to avoid prematurity
■ Baby requires aggressive resuscitation & blood
transfusion
Management

■ If PV bleeding intrapartum

Speculum - fetal vessels.


Investigate for the source of bleeding
Apt test - fetal hemoglobin is alkali resistant.
Wright stain of blood smear.
If fetal bleeding confirmed, immediate cesarean section.

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