Vasa Previa

Vasa previa is a rarely reported condition in which fetal blood vessels unsupported by the umbilical cord or placen-tal tissue traverses the fetal membranes below the presenting part, covering the cervical os. It almost always coexists with a velamentous insertion of the umbilical cord. Vasa previa leads to fetal exsanguination from tearing of the large-caliber fetal vessels when the membranes rupture spontaneously or artificially. This event has an associated fetal mortality of 33% to 100% (Bright and Becker, 1991).

When pulsatile vessels are palpated preceding the fetal vertex during digital examination, vasa previa should be considered along with cord presentation. Vasa previa must be included in the differential diagnosis of all cases of third-trimester bleeding. The blood that is lost can be tested for the presence of fetal hemoglobin, but often there is insufficient time to accomplish this. Vasa previa is often a retrospective diagnosis made after emergent cesarean delivery for fetal distress. Fetal mortality and morbidity from vasa previa may be reduced if there is a high index of suspicion, reliable method of diagnosis, and prompt surgical intervention (Messer et al., 1987).

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