Vasa praevia

Vasa praevia
Vasa praevia
Classification and external resources
Specialty obstetrics
ICD-10 O69.4
ICD-9-CM 663.5
DiseasesDB 13743
eMedicine med/3276

Vasa praevia, also spelled vasa previa, is a complication of pregnancy in which babies blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.

Risk factors include in vitro fertilization.[1]

Vasa praevia occurs in about 0.6 per 1000 pregnancies.[1] The term "vasa previa" is derived from the Latin; "vasa" means vessel and "previa" comes from "pre" meaning "before" and "via" meaning "way". In other words, vessels lie before the baby in the birth canal and in the way. [2]

Cause

Vasa previa is present when unprotected fetal vessels traverse the fetal membranes over the internal cervical os. These vessels may be from either a velamentous insertion of the umbilical cord or may be joining an accessory (succenturiate) placental lobe to the main disk of the placenta. If these fetal vessels rupture the bleeding is from the fetoplacental circulation, and fetal exsanguination will rapidly occur, leading to fetal death. It is thought that vasa previa arises from an early placenta previa. As the pregnancy progresses, the placenta tissue surrounding the vessels over the cervix undergoes atrophy, and the placenta grows preferentially toward the upper portion of the uterus. This leaves unprotected vessels running over the cervix and in the lower uterine segment. This has been demonstrated using serial ultrasound. Oyelese et al. found that 2/3 of patient with vasa previa at delivery had a low-lying placenta or placenta previa that resolved prior to the time of delivery. There are three types of vasa previa. Types 1 and 2 were described by Catanzarite et al. In Type 1, there is a velamentous insertion with vessels running over the cervix. In Type 2, unprotected vessels run between lobes of a bilobed or succenturiate lobed placenta. In Type 3, a portion of the placenta overlying the cervix undergoes atrophy. In this type, there is a normal placental cord insertion and the placenta has only one lobe. However, vessels at a margin of the placenta are exposed.

Risk Factors

Vasa previa is seen more commonly with velamentous insertion of the umbilical cord, accessory placental lobes (succenturiate or bilobate placenta), multiple gestation, IVF pregnancy. In IVF pregnancies incidences as high as one in 300 have been reported. The reasons for this association are not clear, but disturbed orientation of the blastocyst at implantation, vanishing embryos and the increased frequency of placental morphological variations in in vitro fertilisation pregnancies have all been postulated.

Diagnosis

Treatment

It is recommended that women with vasa previa should be delivered by elective cesarean prior to rupture of the membranes. Given that the timing of rupture of membranes is difficult to predict, elective cesarean delivery at 35–36 weeks is recommended. This gestational age gives a reasonable balance between the risk of death and that of prematurity. Several authorities have recommended hospital admission at about 32 weeks. This is to give the patient proximity to the operating room for emergency delivery should the membranes rupture. Because these patients are at risk for preterm delivery, it is recommended that steroids should be given to promote fetal lung maturation. When bleeding occurs, the patient goes into labor, or if the membranes rupture, immediate treatment with an emergency caesarean delivery is usually indicated.[5][6]

See also

References

  1. 1 2 Ruiter, L; Kok, N; Limpens, J; Derks, JB; de Graaf, IM; Mol, B; Pajkrt, E (July 2016). "Incidence of and risk indicators for vasa praevia: a systematic review.". BJOG : an international journal of obstetrics and gynaecology. 123 (8): 1278–87. PMID 26694639.
  2. Yasmine Derbala, MD; Frantisek Grochal, MD; Philippe Jeanty, MD (2007). "Vasa previa". Journal of Prenatal Medicine 2007. 1 (1): 2–13.Full text
  3. Lijoi A, Brady J (2003). "Vasa previa diagnosis and management.". J Am Board Fam Pract. 16 (6): 543–8. doi:10.3122/jabfm.16.6.543. PMID 14963081.Full text
  4. Lee W, Lee V, Kirk J, Sloan C, Smith R, Comstock C (2000). "Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome.". Obstet Gynecol. 95 (4): 572–6. doi:10.1016/S0029-7844(99)00600-6. PMID 10725492.
  5. Bhide A, Thilaganathan B (2004). "Recent advances in the management of placenta previa.". Curr Opin Obstet Gynecol. 16 (6): 447–51. doi:10.1097/00001703-200412000-00002. PMID 15534438.
  6. Oyelese Y, Smulian J (2006). "Placenta previa, placenta accreta, and vasa previa.". Obstet Gynecol. 107 (4): 927–41. doi:10.1097/01.AOG.0000207559.15715.98. PMID 16582134.
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