Manejo de embarazos únicos con diagnóstico antenatal de vasa previa / Management of singleton pregnancies with prenatal diagnosis of vasa previa

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.

Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

Diagnóstico prenatal de vasa previa tipo 3, comunicación de un caso

La vasa previa es una patología poco frecuente en la que los vasos umbilicales se encuentran transcurriendo en las cercanías del orificio cervical interno. Habitualmente está asociada a inserción velamentosa del cordón, placenta succenturiata, inserción baja placentaria y fertilización in vitro. Tiene importantes implicancias perinatales el lograr un diagnóstico precoz en el segundo trimestre, porque se logra disminuir la mortalidad neonatal. Presentamos el primer caso de diagnóstico prenatal de vasa previa tipo 3 (una variante poco conocida) comunicado en el Perú en una gestante con placenta previa y sin diagnóstico hasta el tercer trimestre.

Vasa previa is a rare condition in which the umbilical vessels are found to run in the vicinity of the internal cervical os. It is usually associated with velamentous insertion of the umbilical cord, placenta succenturiata, low placenta insertion and in vitro fertilization. Early diagnosis in the second trimester has important perinatal implications because it reduces neonatal mortality. We present the first case of prenatal diagnosis of vasa previa type 3 (a little known variant) reported in Peru in a pregnant woman with placenta previa and undiagnosed until the third trimester.

Vasa previa con inserción velamentosa de cordón: comunicación de un caso

La afección vasa previa es un hallazgo prenatal raro y poco frecuente de hemorragia en la segunda mitad del embarazo, en la que los vasos umbilicales desprovistos de la gelatina de Wharton se interponen entre la presentación fetal y el orificio cervical interno. Cuando no se la detecta y se produce la rotura de los vasos, se asocia a una alta tasa de mortalidad perinatal. Se describen 3 tipos; el caso presentado se trata de vasa previa de tipo 1 secundaria a inserción velamentosa de cordón. Fue diagnosticada prenatalmente mediante ecografía por vía transvaginal asociada a Doppler color. Se practicó una cesárea con evolución materno perinatal favorable.

Vasa previa is a rare and infrequent prenatal finding of hemorrhage in the second half of pregnancy, in which umbilical vessels devoid of Wharton's jelly interpose between the fetal presentation and the internal cervical os. When undetected and rupture of the vessels occurs, it is associated with a high perinatal mortality rate. Three types are described; the case presented is type 1 vasa previa secondary to velamentous insertion of the cord. It was diagnosed prenatally by transvaginal ultrasound associated with color Doppler. A cesarean section was performed with favorable maternal and perinatal evolution.

Clinical characteristics of vasa previa with low-lying placenta / 中华围产医学杂志

Objective:To investigate the clinical characteristics of vasa previa (VP) with low-lying placenta (LP).Methods:A retrospective case-control study was conducted on pregnant women with VP who delivered at Guangzhou Women and Children's Medical Center from January 2015 to August 2021. According to the status of LP, these cases were classified into VP with LP (VP+LP) and VP without LP (VP-LP) group. The cases diagnosed with placenta previa (PP, n=128) during the same period were collected as control. Maternal-fetal clinical characteristics and outcomes were compared among the three groups using t-test, Mann-Whitney U test, and Chi-square test (or Fisher's exact test). Results:During the study period, 116 VP cases were diagnosed, accounting for 0.085% (116/136 450) of all deliveries. Apart from one case of intrauterine death caused by non-VP reasons in the third trimester, there were 64 in the VP+LP group and 51 in the VP-LP group. VP+LP cases accounted for about 2.9% (64/2 219) of all the cases with PP or LP. The proportions of multiparae and women with a history of cesarean section were significantly higher in the VP+LP group than in the VP-LP group [62.5% (40/64) vs 39.2% (20/51), χ 2= 6.17, P=0.013; 31.3% (20/64) vs 13.7% (7/51), χ 2= 4.85, P=0.028]. Besides, a rare type of VP (type Ⅲ) was only found in the VP+LP group (9.4%, 6/64). The median gestational age at first diagnosis by prenatal ultrasound was significantly larger in the VP+LP group than in the VP-LP group [28.3 (23.6-31.7) vs 23.9 (23.3-25.9) weeks, Z=2.61, P=0.007]. There was no significant difference in the incidence of antepartum hemorrhage between the two groups. In contrast, the amount of postpartum hemorrhage was significantly increased in the VP+LP group [550 (436-732) vs 420 (300-540) ml, Z=3.37, P=0.001]. Compared with the VP-LP group, the VP+LP group showed a lower incidence of lower neonatal Apgar score (<7 at 5 min) and hypoxic-ischemic encephalopathy [0.0%(0/64) vs 6.9%(4/58), 0.0%(0/64) vs 8.6% (5/58), Fisher's exact test, both P<0.05]. No neonatal death was reported in the VP+LP and VP-LP groups. No significant difference in the incidence of antepartum hemorrhage was found between the VP+LP group and the PP group. Still, the median time at delivery was earlier [36.0 (34.3-36.9) vs 37.0 (35.7-37.3) weeks, Z=3.79, P<0.001], and the incidence of abnormal fetal heart rate was higher [10.9% (7/64) vs 3.1% (4/128), Fisher's exact test , P=0.044] in the VP+LP group. Furthermore, the neonatal NICU admission rate and the incidence of respiratory distress syndrome were significantly higher in the VP+LP group than in the PP group [36.4% (24/66) vs 12.1% (16/132), χ 2= 16.04, P<0.001; 25.8% (17/66) vs 12.1% (16/132), χ 2= 5.89, P=0.015]. Conclusions:For VP+LP cases, there might be an additional type (type Ⅲ VP). Patients with VP+LP would have more blood loss within 24 h after delivery and a higher risk of adverse neonatal outcomes. Intensive attention should be paid to those diagnosed with LP during the third trimester to identify any VP.

Vasa previa: a case report

Vasa previa is defined as a condition where fetal vessels traverse the membranes in the lower segment below the presenting part unsupported by placental tissue or umbilical cord. Rupture of the membranes leads to fetal exsanguinations and even neonatal death. The etiology is uncertain, but risk factors include bilobed or succenturiate lobed placenta, velamentous insertion of cord, placenta previa, pregnancies resulting from In vitro fertilization (IVF) and multiple pregnancies. We report here a case of 24 year old woman, G3A2 at 34 weeks of gestation and history of 2 previous spontaneous abortions with vasa previa which was successfully managed. Prenatal sonographic diagnosis has the potential to improve or prevent the poor obstetric and neonatal outcome associated with it.

Rotura de vasa previa en una inserción velamentosa del cordón umbilical / Ruptured vasa previa in a velamentous umbilical cord insertion

RESUMEN La rotura de vasa previa es una afección infrecuente que aparece cuando el cordón umbilical tiene una inserción velamentosa y los vasos fetales desprotegidos, que al carecer de la gelatina de Wharton, discurren a través de las membranas, lo que los hace especialmente vulnerables a la rotura o desgarros. Los factores de riesgo más relevantes son: la gestación gemelar monocorial, las gestaciones conseguidas mediante técnicas de reproducción asistida y las anomalías de inserción placentaria. La rotura de la vasa previa puede llevar a: una hemorragia fetal aguda, un choque hipovolémico, una asfixia fetal y a la muerte perinatal. El estudio ecográfico de la placenta y el empleo del Doppler color tienen gran importancia para lograr el diagnóstico precoz de las pacientes en riesgo, el cual constituye la premisa fundamental para lograr disminuir la morbilidad y mortalidad fetal y neonatal.

ABSTRACT Ruptured vasa previa is an uncommon condition that appears when the umbilical cord has a velamentous insertion and the unprotected fetal vessels, which, in the absence of Wharton's jelly, run through membranes making them especially vulnerable to rupture or tears. The most relevant risk factors are: monochorionic twin pregnancy, pregnancies achieved through assisted reproductive techniques and abnormal placental cord insertion. Ruptured vasa previa can lead to: acute fetal hemorrhage, hypovolemic shock, fetal asphyxia and perinatal death. The ultrasound study of the placenta and the use of color Doppler ultrasound are of great importance to achieve early diagnosis of patients at risk, which is the fundamental premise to achieve lower fetal and neonatal morbidity and mortality.

In vitro fertilization and vasa previa: A report of two cases / Fertilização in vitro e vasa previa: relato de dois casos

Abstract Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-yearold primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.

Resumo Vasa previa (VP) é uma condição obstétrica perigosa associada a mortalidade e morbidade perinatais. Fertilização in vitro (FIV) é um fator de risco para VP devido à alta incidência de placentação anormal. O diagnóstico deve ser realizado no período pré-natal, pois a possibilidade de mortalidade fetal é extremamente elevada. Relatamos dois casos para demonstrar a acurácia da ultrassonografia transvaginal no diagnóstico pré-natal de VP. Mulher caucasiana, primigesta, de 40 anos, submetida a FIV, foi diagnosticada com VP na 29ª semana de gestação e hospitalizada para observação na 31ª semana de gestação. A paciente foi submetida à cesariana eletiva com 34 semanas e 4 dias, sem complicações, com recém-nascido do sexo masculino, pesando 2.380 g, e com Apgar de 10 no 5° minuto. Mulher caucasiana, primigesta, de 36 anos, subetida a FIV, foi diagnosticada com placenta prévia, placenta bilobada, acretismo placentário e VP. Cordão umbilical com inserção velamentosa. A paciente foi hospitalizada para observação na 26ª semana de gestação. Foi submetida à cesariana de emergência com33 semanas e 4 dias por sangramento vaginal. O recém nascido do sexo feminino pesou 2.140 g, com Apgar de 9 no 5°minuto. O diagnóstico de VP no período pré-natal associou-se a um desfecho favorável nos dois casos, corroborando observações anteriores de que a FIV é um fator de risco para VP e de que todas as gestações por FIV deveriam ser avaliadas por ultrassonografia transvaginal.

Clinical value of prenatal ultrasound in diagnosis of vasa previa / 中国医学影像技术

Objective: To explore the clinical value of prenatal ultrasound in diagnosis of vasa previa. Methods: The images of 65 230 pregnant women who underwent prenatal ultrasound examination were analyzed retrospectively. The accuracy of prenatal ultrasound in diagnosis of vasa previa was calculated. The delivery modes of all pregnant women and outcomes of all perinatal infants with vasa previa diagnosis were followed up. Results: Fifty-three vasa previa cases were diagnosed during the first examination using prenatal ultrasound and 10 cases were eliminated during reexamination in late pregnancy, so 43 cases were diagnosed. Finally 41 cases (41/65 230, 0.06%) were clinically confirmed. The accuracy of middle pregnancy screening (15-28 weeks) and late pregnancy (28-40 weeks) reexamination was 100%(28/28), and the accuracy of late pregnancy was 86.67%(13/15). Cesarean section surgery was performed in all 41 pregnant women, and all fetuses survived. Conclusion: Prenatal ultrasound has a high value of prenatal ultrasound in diagnosis of vasa previa.

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa / 中华超声影像学杂志

Objective To investigate the prenatal ultrasonographic features and prognosis of vasa previa,to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound,then to increase vasa previa detection rate.Methods Prenatal ultrasound images,clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively,the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.Results Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth,with a detection rate of 94.3 ％ (33/35).Of the 35 cases,20 cases (60.6 ％) were first contacted in second trimester and 13 cases (39.4％) were first contacted in third trimester.Two cases were missed or misdiagnosed,which were all first contact in third trimester.Among the 35 cases,25 were velamentous placenta and 4 were battledore placenta.Twenty cases were low-lying placenta or marginal placenta previa.All 35 women underwent cesarean section.No neonatal mortality,11 term infants,20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks.All placentas underwent pathological examination after delivery,4 cases placentas underwent vascular casting,and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.Conclusions Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth.Second trimester is the best period to detect vasa previa.Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa / 中华超声影像学杂志

Objective@#To investigate the prenatal ultrasonographic features and prognosis of vasa previa, to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound, then to increase vasa previa detection rate.@*Methods@#Prenatal ultrasound images, clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively, the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated.@*Results@#Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth, with a detection rate of 94.3% (33/35). Of the 35 cases, 20 cases (60.6%) were first contacted in second trimester and 13 cases (39.4%) were first contacted in third trimester. Two cases were missed or misdiagnosed, which were all first contact in third trimester. Among the 35 cases, 25 were velamentous placenta and 4 were battledore placenta. Twenty cases were low-lying placenta or marginal placenta previa. All 35 women underwent cesarean section. No neonatal mortality, 11 term infants, 20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks. All placentas underwent pathological examination after delivery, 4 cases placentas underwent vascular casting, and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch.@*Conclusions@#Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth. Second trimester is the best period to detect vasa previa. Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa.

Placenta succenturiata. Reporte de un caso / Succenturiate placenta. Case report

Resumen La placenta succenturiata es una anomalía morfológica de la placenta donde se presentan uno o más lóbulos accesorios por fuera del cuerpo placentario, pueden ser de diferentes tamaños y estar conectados mediante vasos sanguíneos a la placenta principal. El lóbulo accesorio se desarrolla a partir de las vellosidades coriónicas no asociadas al corion leve. La incidencia estimada a nivel mundial es de 1.04% y los principales factores de riesgo asociado a esta entidad son edad materna avanzada y el antecedente de haberse sometido a fertilización in vitro. Presentamos el caso de una paciente de 18 años con diagnóstico de placenta succenturiata con inserción marginal y velamentosa del cordón umbilical, la cual tuvo la finalización de la gestación por parto eutócico en el que se obtuvo recién un nacido eutrófico y sano, con tercer período de trabajo de parto prolongado y retención placentaria, por lo que se realizó alumbramiento manual, y se obtuvo la placenta completa con la presencia de un lóbulo accesorio con conexiones vasculares con el cuerpo placentario. En conclusión, la placenta succenturiata es una anormalidad morfológica relativamente rara, de diagnóstico clínico y morfológico en el puerperio inmediato, sin embargo, debe buscarse de manera intencionada mediante ultrasonido Doppler color en el período prenatal debido a que esta variedad de placenta conlleva a riesgos que pueden comprometer la salud y la vida tanto del feto como de la madre.

Abstract Placenta succenturiate is a morphological anomaly of the placenta where one or more of the lobes are present at a distance, which can be of different sizes and are connected by blood vessels to the main placenta. The accessory lobe develops from the chorionic villi that did not involute from the mild chorion. The estimated incidence worldwide is 1.04%. This entity has been associated with two main risk factors, advanced maternal age and women who have undergone in vitro fertilization. We report the case of a finding of placenta succenturiate in the postpartum period, in an 18-year-old woman in her first pregnancy, with vaginal delivery, eutrophic and apparently healthy newborn was obtained. During the third period of labor the patient presented placental retention, for which manual delivery was performed, obtaining a complete placenta that upon inspection was observed the presence of an accessory lobe in the membranes, which had vascular connections with the main placenta. In conclusion, placenta succenturiata is a relatively rare morphological abnormality, diagnosed in the postpartum period, but it can be diagnosed intentionally by color Doppler ultrasound in the prenatal period. This variety of placenta carries many risks that can compromise the health and life of both the fetus and the mother.

Alteraciones morfológicas de la placenta / Placenta Morphological Changes

Suelen reportarse casos aislados de anomalías morfológicas placentarias; pero últimamente existe una incidencia del 9 % digna de atención. La placenta puede tener diferentes anomalías o producir alteraciones que complican el embarazo, el parto o el puerperio. Se presenta un caso clínico de una paciente con inserción velamentosa del cordón y placenta bilobulada en el Hospital Ginecobstétrico Docente “Ramón González Coro” durante un parto eutócico. Los resultados perinatales, a pesar de todas las complicaciones, fueron favorables y el recién nacido presentó un conteo de Apgar adecuado al nacimiento. A pesar de los pocos casos reportados se confirmó la relación entre el retardo fetal y la morbilidad hemorrágica materna en el alumbramiento.

Isolated cases of placental morphological abnormalities are often reported; but lately there is an incidence of 9 % noteworthy. The placenta may have different abnormalities or alter complicating pregnancy, childbirth, and the postpartum period. A case of a patient with velamentous cord insertion and bilobed placenta during a vaginal delivery at Ramón Gonzalez Coro Gynecobstetric Teaching Hospital is presented here. Perinatal outcomes, despite all the complications were favorable and the newborn presented a proper Apgar count at birth. Despite the few reported cases, the relationship between fetal delay and maternal hemorrhagic morbidity at delivery was confirmed.

Vasa previa, presentación de un caso en un centro de referencia en Envigado, Colombia, y revisión de la literatura / Vasa previa, case presentation from a referral center in Envigado, Colombia, and review of the literature

Objetivo: reportar un caso de vasa previa y hacer una revisión de la literatura en cuanto a la patogénesis, el diagnóstico ecográfico antenatal y el pronóstico perinatal de la misma.Materiales y métodos: se presenta el caso de una paciente de 44 años de edad y 36 semanas de gestación, que consultó al Hospital Manuel Uribe Ángel (HMUA), institución pública de segundo nivel de atención, centro de referencia obstétrica ubicado en el municipio de Envigado, Antioquia. Se utilizó como fuente de información la historia clínica, se realizó una búsqueda de literatura con las palabras clave “vasa previa”, “ultrasonography”, “prognosis” en las bases de datos Medline vía PubMed de los años 1993 a 2013 en inglés y español; se buscaron revisiones de tema, revisiones sistemáticas y reportes de caso.Resultados: se encontraron 35 artículos, se analizaron todas las referencias y se halló que 22 corresponden a reportes de caso, 8 a revisiones de tema y 5 a revisiones sistemáticas.Conclusiones: la vasa previa es una complicación obstétrica poco frecuente. La evaluación de la placenta por ultrasonido es un método útil para determinar la inserción del cordón umbilical y sus posibles anormalidades. El pronóstico es pobre, con altos índices de mortalidad fetal si no se realiza un diagnóstico antenatal.

Objective: To report a case of vasa previa and a review of the literature in terms of the pathogenesis, pre-natal ultrasound diagnosis, and perinatal prognosis.Materials and methods: We present a case of a 44 year-old woman in her 36th week of gestation who came to Hospital Manuel Uribe Ángel (HMUA), a level II public referral center in Envigado, Antioquia. The clinical record was used as a source of information. The search of the literature was conducted using the key words vasa previa, ultrasonography, prognosis in the Medline databases through PubMed between 1993 and 2013, in English and Spanish. The search focused on topic reviews, systematic reviews, and case reports.Results: Overall, 35 articles were found, all the references were analyzed, resulting in 22 case reports, 8 topic reviews, and 5 systematic reviews.Conclusions: Vasa previa is an infrequent obstetrical complication. Ultrasound placental assessment is a useful tool to determine umbilical cord insertion and potential abnormalities. Prognosis is poor, with high rates of fetal mortality in the absence of pre-natal diagnosis.

Inserção velamentosa do cordão umbilical: diagnóstico intraparto / Velamentous insertion of the umbilical cord: intrapartum diagnosis

Relata-se a inserção velamentosa do cordão umbilical diagnosticada durante o parto gemelar normal, evento raro e com mais incidência em gestações múltiplas. É, em geral, assintomático, quando a paciente não entra em trabalho de parto, devendo a gestação ser interrompida por cesariana. A vasa prévia constitui-se em sua complicação rara, podendo ser letal. A ultrassonografia é fundamental para a realização de seu diagnóstico.

A report of velamentous insertion of the umbilical cord diagnosed during a normal twin delivery, a rare event with higher incidence in multiple pregnancies. Because it is generally asymptomatic, when the mother does not go into labor, pregnancy must be interrupted by performing a caesarean delivery. Previous vasa is a rare complication and can be lethal. Ultrasound is crucial for diagnosis.

Bedside Ultrasonography for Emergent Patients in the Diagnosis of Vasa Previa and Umbilical Cord Prolapse / 中国医学影像学杂志

Purpose To investigate the value of bedside ultrasonography for emergent patients in the diagnosis of vasa previa and umbilical cord prolapse. Materials and Methods The bedside ultrasonography data of 12 emergent cases of vasa previa and 18 emergent cases of umbilical cord prolapse were retrospectively analyzed for detection rate. Results Nine out of 12 emergent patients with vasa previa were detected by bedside ultrasonography;2 were misdiagnosed as umbilical cord prolapsed;and 1 patient who had missed diagnosis suffered fetal demise during vaginal labour. Fifteen out of 18 emergent patients with umbilical cord prolapse were detected by bedside ultrasonography;2 were misdiagnosed as vasa previa; and 1 missed diagnosis (no death case was reported). The detection rates for both groups of patients had no significant difference (P>0.05). Conclusion Bedside ultrasonography for emergent patients can visualize the traveling of vasa previa and umbilical cord prolapse so as to promptly provide evidence for clinical diagnosis and reduce perinatal mortality.

Hemorragia fetal aguda letal por rotura de vasa previa / Lethal acute fetal hemorrhage from ruptured vasa previa

La vasa previa es una afección rara asociada a una elevada mortalidad perinatal. Los vasos sanguíneos fetales cruzan por encima del orificio cervical interno y son el resultado de una inserción velamentosa del cordón umbilical. Se presenta un caso de sufrimiento fetal agudo letal causado por rotura de un vaso previo durante el segundo periodo del parto. Se comenta la etiología y el manejo clínico de esta afección.

Vasa previa is a rare condition associated with high perinatal mortality. Fetal blood vessels cross over the internal os and they are the result of an insertion cord velamentous. We report a case of fatal acute fetal distress caused by rupture of a vessel in the second period before delivery. We discuss the etiology and clinical management of this condition.

Vasa previa y corioamnionitis: imágenes de un riesgo continuo / Vasa previa and chorioamnionitis

We are presenting a case of vasa previa diagnosed at 22 week’s gestation and then she started with threatened premature labor on week 27th.In spite of attempted tocolysis, labor continued to painless fully dilatation, spontaneous rupture of membranes, umbilical cord prolapse and unexpectedvaginal delivery of a 760 g baby in good conditions. Gross placental examination was in agreement with ultrasound findings and microscopic study demonstrated chorioamnionitis and funisitis associated to vasa previa and prematurity. We consider series of facts that happened in this case as a continuous risk condition from the morbidity to the epilog like “near miss perinatal case”. We discuss the importance of chance in the resultand we think that the preventive intervention was in the medical management and not in the attention system.

Se presenta un caso clínico de vasa previa diagnosticada con ultrasonido a las 22 semanas que evolucionó con amenaza de parto prematuro en semana 27. Pese a la frenación inicial se produjodilatación completa en forma silenciosa, rotura de membranas, procidencia de cordón y parto vaginal sorpresivo de un prematuro de 760 gramos que tuvoevolución favorable. El examen macroscópico placentario fue concordante con las imágenes observadas con ultrasonido y el estudio histológico confirmó corioamnionitis y funisitis asociadas a la vasa previa y la prematurez. La interpretación de la secuencia de eventos es de un riesgo continuo desde su inicio como morbilidad y su epílogo de probable mortalidad perinatal (“near miss”).Se discute la importancia del azar en la evolución y se concluye que una intervención preventiva estuvo en el ámbito del manejo médico y no en el sistema de atención.

One case of prenatally diagnosed vasa previa accompanied by succenturiate placenta / 대한산부인과학회지

Vasa previa is said to occur when fetal vessels, unsupported by placenta or umbilical cord, transverse the menbranes over the cervix, below the presenting part. It is typically caused by velamentous insertion of the umbilical cord with fetal vessels between the cervix and presenting part. Bilobed or succenturiate placentas also can be associated with aberrant vasculature over the internal cervical os. Vasa previa has an incidence of approximately one per 2,000-5,000 deliveries. It has a high fetal mortality due to fetal exsanguination resulting from fetal vessels tearing when the menbranes rupture. So Prenatal detection of vasa previa is very important. We believe transvaginal ultrasound in combination with color Doppler is the most effective tool in the antenatal diagnosis of vasa previa. Recently, we experienced one case of vasa previa accompanied by succenturiate placenta diagnosed prenatally by color Doppler and transvaginal sonography. Here we report our experience with a literature review.

A Case of Vasa Previa / 대한산부인과학회잡지

Vasa previa is one of the most unusual and tragic accidents to fetus in obstetrics. This condition is not diagnosed easily because it is rare and unexpected. To improve the perinatal outcome, early detection by ultrasonography is very important during pregnancy. We present a case of vasa previa with velamentous insertion of cord with a brief review of the literatures concerned.