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A potentially lethal case of Vasa Previa reported by NEJM

A potentially lethal case of Vasa Previa reported by NEJM

Dr Shinya Matsuzaki, at Osaka University, Osaka, Japan and colleagues have reported a rare and potentially lethal case of Vasa Previa that has appeared in NEJM.

Vasa Previa is a condition in which fetal blood vessels are within 2 cm of the internal cervical os or traverse it without protection from the placenta or Wharton’s jelly. These unprotected fetal blood vessels are at high risk for rupture during labour and vaginal delivery; cesarean delivery before rupture of the membranes is indicated. vasa Previa is associated with very high fetal mortality rates and is often not detected until catastrophic events occur.

There have been reports estimating the incidence of vasa previa as being about 1 of every 5000 deliveries. The mortality rate has been reported to be as high as 33% to 100%9 following spontaneous or artificial rupture of the membranes.

According to history, a  37-year-old woman presented to the obstetrical clinic for routine fetal ultrasonography at 27 weeks of gestation. Her vaginal ultrasonography was carried out which revealed a low-lying posterior placenta and velamentous cord insertion (i.e., rather than being inserted centrally on the placenta, the umbilical cord was affixed to the fetal membranes and tracked the surface of the membranes to the placenta).

Courtesy NEJM

The Transvaginal colour Doppler ultrasonography of the patient revealed fetal blood vessels covering the internal cervical os, a finding consistent with vasa previa. The patient underwent a scheduled cesarean delivery at 34 weeks of gestation.

A low, transverse uterine incision revealed an intact amniotic membrane with fetal blood vessels crossing over the membrane that covered the head of the fetus. Examination of the placenta revealed membranous vessels that merged to form the umbilical cord, confirming the presence of velamentous cord insertion. The infant had transient tachypnea of the newborn but recovered well, and both mother and baby were ultimately discharged home.

For more details click on the link: DOI: 10.1056/NEJMicm1808778

Source: self

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  1. Recently I came across with a case of vasa previa where the condition was diagnosed by chance while performing artificial rupture of membrane. This was a 34 years-year-old from rural Haryana, unbooked multi gravid (p3+0),with 36 and half wk. gestation, admitted in early labor at our hospital. Her U/S was done once at 30weeks gestation. Ultrasound reported a single viable fetus in cephalic presentation with normal growth parameters with heart beats 134/ minute. Expected fetal weight was2000 gm +/- 150 gm, AFI was 9.2cm; placenta was low lying at the anterior wall and away from the os. Per vaginal examination revealed 5cm dilated cervical os with well formed bag of membrane. The vertex felt at ‘0’ station. A distinct pulsation was felt over the bulging bag of membrane which gave us a suspicion of rare possibility of Vasa previa. ARM was abandoned and the patient was taken to OT for further evaluation. A gentle speculum examination made our suspicion stronger. Decision for emergency caesarean section was taken. LSCS was done under spinal anesthesia. A male baby of approximately 36 wks weighing 2.3 kg was delivered in good condition. Placenta was situated in the anterior wall of the uterus. A small lobe of placenta with infarction was found on the lower segment of the posterior wall. A diagnosis of succenturiate placenta with Vasa previa was made. Post LSCS period was uneventful. The patient with the baby was discharged on third post operative day in good condition. If Vasa previa is diagnosed antenatally, cesarean section delivery should be planned before the onset of labor, preferably by 35-36 weeks of gestation to avoid spontaneous rupture of membrane. In such cases early hospitalization and administration of corticosteroids for lung maturity may be needed. . As many studies have confirmed that the condition can be diagnosed accurately and with very high degree of sensitivity and specificity by transvaginal ultrasound using color Doppler, I am of the opinion that sonologist should specially look for this condition to all women with one or more risk factors while doing 2nd trimester U/S which adds little or no extra time to the duration of the obstetric sonographic examination. This will be of enormous help to avoid tragic complication of neonatal mortality and morbidity associated with Vasa previa.)