Vasa previa is a rare pregnancy complication that can lead to severe blood loss for your fetus if it’s not carefully managed. With vasa previa, unprotected blood vessels from the umbilical cord travel across the opening of your cervix (or cervical os). When your water breaks during labor, the exposed blood vessels can burst, causing severe blood loss for your fetus or even death. Diagnosing vasa previa early and delivering your baby via c-section can prevent these complications from occurring.
Vasa previa is rare, occurring in approximately 1 in every 2,500 deliveries. Vasa previa occurs more often in pregnancies involving IVF, about 1 in every 200 deliveries.
You may not notice symptoms with vasa previa. Instead of arriving at a diagnosis based on symptoms, your healthcare provider will likely detect vasa previa during a routine pregnancy ultrasound.
In rare instances, people with vasa previa may notice painless vaginal bleeding around the second or third trimester. The blood may be a darker red than is typical, which can be a sign that it’s fetal blood instead of your own. See your provider immediately if you notice bleeding during pregnancy, with or without pain.
There are two main causes of vasa previa:
• Velamentous cord insertion. During pregnancy, your baby is nourished by your placenta through the umbilical cord. The umbilical cord normally attaches to the center of the placenta, and the blood vessels are protected inside of this structure. In velamentous cord insertion, the umbilical cord inserts into the amniotic sac instead of the placenta.
When blood vessels run through the amniotic sac, they don’t have that protection. If the blood vessels in the amniotic sac are above the cervix, it causes vasa previa.
• Bilobed, multilobed, or succenturiate placenta. Your placenta can form two lobes, which is called a bilobed placenta. Rarely, it can form more than two lobes, which is called multilobed. Sometimes a smaller lobe, called a succenturiate lobe, forms. Vasa previa happens if the blood vessels that run between these lobes end up lying against the cervix.
When your baby is ready to be born, the amniotic sac ruptures. The baby then moves through the cervix and out through the vagina. If you have vasa previa, the rupture of the amniotic sac will also rupture the blood vessels. This will cause your baby and possibly you to lose a lot of blood.
Risk Factors –
This complication is associated with the following conditions:
• Placenta previa, which is when the placenta partially or fully covers the cervix
• In vitro fertilization
• Pregnancy with multiple babies
• Pregnancy later in life
• Chronic health conditions such as diabetes
The best method for detecting vasa previa is to do a transvaginal scan combined with a color Doppler.
The goal of its treatment is to safely prolong your pregnancy but deliver your baby early enough to avoid rupturing the blood vessels. Treatment may include –
• Monitoring your baby with nonstress tests twice a week, starting between 28 and 32 weeks.
• You may be admitted to the hospital between 30 and 32 weeks to more closely monitor the baby.
• You may be given a shot of corticosteroids to help your baby’s lungs mature.
• Pelvic rest may be advised, which means avoiding sex or putting anything in your vagina.
• Planned C-section delivery between 34 and 37 weeks.
• You may need an emergency C-section if your membranes rupture early, you have vaginal bleeding, or your baby is in distress.
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