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.