Current Diagnosis And Management Of Vasa Praevia

Vasa praevia represents a rare obstetrical complication (1/2500 births), considered under-reported in the specialty literature. The condition is characterized by crossing of the fetal vessels in front of the internal cervical opening (OCI) and the uterine segment covered at this level only by membranes. It is classified into three morphological and clinical types, depending on the ethiology. Unlike placenta praevia, vasa praevia does not present any major maternal risk but is associated with significant risk for the fetus. The management in our clinic overlaps with current guidelines for antenatally diagnosed patients with vasa praevia: corticotherapy at 28-32 weeks of gestation, admission in a tertiary maternity at 30-32 weeks, elective cesarean delivery at 34-37 weeks (35 weeks in most guidelines) prior to the onset of labour or rupture of amniotic membranes. We present a case diagnosed antenatally with lateral placenta praevia with vasa praevia. At 28 weeks of gestation, she presents at the emergency room accusing bleeding, with red blood, in medium quantity, without any uterine contractions or acute fetal distress signs with reassuring non-stress test (NST) and she is continuously hospitalized. At 35 weeks of gestation, the scheduled cesarean section is performed without any intraoperative incidents, and a female fetus weighing 2350 grams is born, with good neonatal adaptation. The postoperative inspection of placenta, membranes and umbilical cord revealed velamentous cord insertion - type 1 vasa praevia.