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VASAPREVIA and VELAMENTOUS PLACENTA

VASAPREVIA and VELAMENTOUS PLACENTA. Obstetric emergency Complication of labour Major cause of antepartum hemorrhage Refers to anomalies of umbilical cord. Velamentous placenta.

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VASAPREVIA and VELAMENTOUS PLACENTA

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  1. VASAPREVIA and VELAMENTOUS PLACENTA

  2. Free template from www.brainybetty.com

  3. Obstetric emergency • Complication of labour • Major cause of antepartum hemorrhage • Refers to anomalies of umbilical cord Free template from www.brainybetty.com

  4. Velamentous placenta • Incidence: 1% - singleton pregnancies, 8.7% - twin pregnancies, higher in early pregnancy & spontaneous abortion. • Normally: Umbilical cord usually inserts on placental mass - 99% cases. • Velamentous placenta - cord inserted on chorioamniotic membrane. • Variable amount of cord unprotected by Wharton’s jelly. • Vasa praevia coexisting in 6% singleton pregnancies with velamentous insertion. Free template from www.brainybetty.com

  5. Free template from www.brainybetty.com

  6. Free template from www.brainybetty.com

  7. Definition of vasa previa Fetal vessels crossing or running in close proximity to the inner cervical os. These vessels course within the membranes (unsupported by the umbilical cord or placental tissue) and are at a risk of rupture when the supporting membranes rupture. Free template from www.brainybetty.com

  8. Pathology • Unknown • Phototropism - Lower segment not nourishing - placenta grows upwards to reach more nourishing tissue. Free template from www.brainybetty.com

  9. Risk factors • Low lying placenta • Placenta previa • Multiple pregnancies • Multilobate placenta • Velamentous insertion • Multifetal pregnancy • Placenta membranacea • Invitro fertilization Free template from www.brainybetty.com

  10. Symptoms of Velamentous placenta • Asymptomatic • Sudden onset of painless bleeding in 2nd or 3rd trimester or at artificial or spontaneous rupture of membranes • Heavy or small amount of bleeding. • No sign symptom of Placenta praevia or abruption. Signs • IUGR/ Congenital malformation Free template from www.brainybetty.com

  11. Clinical Features of vasa previa Vaginal bleedingIS THE ONLY SYMPTOM Diagnostic measures • Digitalpalpation of vasa previa • Amnioscopy • Fetal blood detection • USG • MRI • Fresh bleeding per vagina Free template from www.brainybetty.com

  12. Management • Immediate consultation • Assess the presenting part • Fetal heart rate • During first stage: • Fetus is alive • Caesarean section • During second stage: watch for spontaneous delivery Vaginal birth Free template from www.brainybetty.com

  13. Care of the newborn • Presence of the pediatrician • Hemoglobin estimation • Resuscitation • Blood transfusion Free template from www.brainybetty.com

  14. Associated anomalies • Cephalocele • Trisomy • Heart rate anomalies • Small for gestational age • Intraventricular hemorrhage • Intrauterine fetal death Free template from www.brainybetty.com

  15. Prognosis • Rupture of vessels • Median Apgar score • Transfusion • Compressed vasaprevia • Postnatal complications • Hyaline membrane disease • Bronchopulmonary dysplasia • Transient tachypnea • Respiratory disease syndrome Free template from www.brainybetty.com

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