1. VASAPREVIA and VELAMENTOUS PLACENTA

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Obstetric emergency
Complication of labour
Major cause of antepartum hemorrhage
Refers to anomalies of umbilical cord
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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.
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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.
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Pathology
Unknown
Phototropism - Lower segment not nourishing - placenta grows upwards to reach more nourishing tissue.
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Risk factors
Low lying placenta
Placenta previa
Multiple pregnancies
Multilobate placenta
Velamentous insertion
Multifetal pregnancy
Placenta membranacea
Invitro fertilization
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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
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11. Clinical Features of vasa previa
Vaginal bleeding IS THE ONLY SYMPTOM
Diagnostic measures
Digital palpation of vasa previa
Amnioscopy
Fetal blood detection
USG
MRI
Fresh bleeding per vagina
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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
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Care of the newborn
Presence of the pediatrician
Hemoglobin estimation
Resuscitation
Blood transfusion
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Associated anomalies
Cephalocele
Trisomy
Heart rate anomalies
Small for gestational age
Intraventricular hemorrhage
Intrauterine fetal death
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Prognosis
Rupture of vessels
Median Apgar score
Transfusion
Compressed vasaprevia
Postnatal complications
Hyaline membrane disease
Bronchopulmonary dysplasia
Transient tachypnea
Respiratory disease syndrome
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