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Vasa Praevia

Vasa Praevia. Rare - 1 in 3000Fetal vessels run in the membrane below the presenting fetal part, unsupported by placental tissue or umbilical cordSpontaneous or artificial rupture of membranes - rupture these vessels - fetal exsanguination. Hypoxia if the vessels are compressed between baby

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Vasa Praevia

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    1. Vasa Praevia Dr Fatima Z Ashrafi DGO (Dub), FRCS (Edin), MRCOG (Lon), FRANZCOG Gisborne Hospital, New Zealand

    2. 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.

    3. 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

    4. 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.

    6. Velamentous insertion of cord

    7. Twin Placenta with a succenturiate lobe

    8. Circumvallate Placenta.

    9. 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

    10. 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.

    11. Doppler scan to detect Vasa praevia - 1

    12. Doppler scan to detect Vasa praevia - 2

    13. 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

    14. 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.

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