Vasa praevia

Cards (7)

Normally, the foetal vessels are protected within the umbilical cord or placenta.
In vasa praevia, the vessels are exposed which increases the risk of the vessels rupturing following rupture of the supporting membranes
Vasa praevia occurs when fetal blood vessels (the two umbilical arteries and single umbilical vein) are within the fetal membranes and run across the internal cervical os.
Types:
Vasa praevia with velamentous umbilical cord insertion - foetal vessels insert into the membranes and travel round to the placenta, rather than inserting directly into the placenta
With multilobed placenta - foetal vessels are exposed as they travel to an accessory placental lobe
Risk factors:
IVF pregnancy
Multiple pregnancy
Low lying placenta
Presentation:
Painless vaginal bleeding - indicated when bleeding straight after membranes rupture
Ruptured membranes
Soft, non-tender uterus
Foetal bradycardia
Management:
If found to have vasa praevia on ultrasound, an elective caesarean section at 34-36 weeks is recommended
Corticosteroids are given from 32 weeks to promote foetal lung maturity
In the event of APH, an emergency caesarean section is required
Foetal morality rate is at least 60% despite urgent caesarean section
This is massively improved if diagnosis made antenatally followed by elective LSCS