From the Research
Introduction to Vasa Previa
Vasa previa, also known as placental vessel prolapse, is a rare and potentially life-threatening condition for the fetus, where unprotected fetal vessels run through the membranes over the cervix [ 1, 2 ].
Risk Factors
Several risk factors have been identified for vasa previa, including:
- Second-trimester placenta previa and low-lying placentas
- Velamentous cord insertion
- Placentas with accessory lobes
- In vitro fertilization
- Multifetal gestations [ 2, 3 ]
Prevention Strategies
Prevention of vasa previa involves early prenatal diagnosis using ultrasound and color Doppler imaging [ 1, 4 ].
Signs and Symptoms
The signs and symptoms of vasa previa may not be apparent until the membranes rupture, at which point fetal exsanguination can occur [ 2 ].
Diagnosis
Diagnosis of vasa previa is made by visualization of velamentous fetal vessels coursing within the membranes over the cervix unprotected by Wharton jelly or placenta [ 3 ].
Treatment Options
Treatment options for vasa previa include:
- Hospitalization or management as outpatients
- Cesarean delivery in a tertiary center with experienced clinicians [ 1, 4 ]
- Elective cesarean section prior to membrane rupture [ 5 ]
- Close surveillance and appropriately timed late preterm delivery by cesarean [ 3 ]
Management Considerations
Management strategies for vasa previa depend on each institutional policy and may involve:
- Inpatient management for patients with complications
- Outpatient management for carefully selected asymptomatic patients [ 5 ]
Dosing and Duration
There is no specific dosing information relevant to the treatment of vasa previa.
Differential Diagnosis
Differential diagnosis for vasa previa includes other placental abnormalities, such as placenta previa.
Caveats
It is essential to note that outcomes continue to be dismal when vasa previa is undiagnosed before labor [ 2 ]. Therefore, early prenatal diagnosis and appropriate management are crucial to reduce the risks associated with vasa previa.