1. VASA PREVIA Dr.Nasir Rafiq CDA,Islamabad Dr.Nasir Rafiq CDA,Islamabad

2. What is Vasa Previa? Vasa previa is an obstetric complication in which the fetal blood vessels cross or run near the internal orifice 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.  This complication can happen during labour.

3. Vasa Previa Explanation

4. Vasa Praevia

5. Vasa Previa

6. Causes 1. A low lying placenta.  It can be due to scarring of the uterus as a result of previous miscarriage and D/C ( Dilatation and Curettage) 2. An abnormally or unusually form placenta.  It can be a bilobed placenta or succenturiate- low placenta.

7. Causes 3. In cases of in-vitro fertilization pregnancies and multiple pregnancies ( twins, triplets, etc) 4. In case of velamentous insertion of umbilical cord.

8. Diagnosis By noting the triad signs  Painless vaginal bleeding  Membrane rupture  Fetal bradycardia or death. Ultrasonography  Transvaginal sonography in combination with color doppler help to detect vasa previa as early as 16th week of pregnancy.

9. Symptoms There are no warning sign but these can be...  Painless vaginal bleeding (2nd and 3rd trimester)  Darker red color blood (as the baby blood is dark in color, bright red blood signifies blood from the mother.)  Fetal bradycardia

10. Treatment The only treatment plan to be followed is a healthy delivery by cesarean section. Cesarean section should be planned as early enough to avoid an emergency and should be late enough in orde to prevent the problems related with prematurity. Usually cesarean section is recommonded at 35-36 weeks provided the mother is normal without any risk.

11. Diagnosis

12. The purpose of this guideline is to describe the diagnostic modalities and review the evidence-based approach to the clinical management of pregnancies complicated by vasa praevia Vasa Praevia:(Green-top Guideline 2018)

13. Vasa praevia is uncommon in the general population with a prevalence ranging between 1 in 1200 and 1 in 5000 pregnancies, although the condition may have been under-reported.

14. Vasa Praevia:(Green-top Guideline 2018) Vasa praevia occurs when the fetal vessels run through the free placental membranes. Unprotected by placental tissue or Wharton’s jelly of the umbilical cord, a vasa praevia is likely to rupture in active labour, or when amniotomy is performed to induce or augment labour, in particular when located near or over the cervix, under the fetal presenting part.

15. Vasa Praevia:(Green-top Guideline 2018) Vasa praevia is classified as Type I >>when the vessel is connected to a velamentous umbilical cord Type II >>when it connects the placenta with a succenturiate or accessory lobe.

16. Vasa Praevia:(Green-top Guideline 2018) Diagnosis Vasa praevia may be diagnosed during early labour by vaginal examination, detecting the pulsating fetal vessels inside the internal os, or by the presence of dark-red vaginal bleeding and acute fetal compromise after spontaneous or artificial rupture of the placental 3membranes

17. Vasa Praevia:(Green-top Guideline 2018) Diagnosis The fetal mortality rate in this situation is at least 60% despite urgent caesarean delivery. However, improved survival rates of over 95% have been reported where the diagnosis has been made antenatally by ultrasound followed by planned caesarean section.