Vasa praevia (vasa previa AE) is an obstetric complication defined as "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 risk of rupture when the supporting membranes rupture."[1] Etiology/Pathophysiology Vasa previa is present when fetal vessels traverse the fetal membranes over the internal cervical os. These vessels may be from either a velamentous insertion of the umbilical cord or may be joining an accessory (succenturiate) placental lobe to the main disk of the placenta. If these fetal vessels rupture the bleeding is from the fetoplacental circulation, and fetal exsanguination{ex (out of) sanguis (blood) or bleeding to death} will rapidly occur, leading to fetal death. Risk Factors Vasa previa is seen more commonly with velamentous insertion of the umbilical cord, accessory placental lobes (succenturiate or bilobate placenta), and multiple gestation.

Vasa previa: A condition in which blood vessels within the placenta or theumbilical cord are trapped between the fetus and the opening to the birth canal, a situation that carries a high risk the fetus may die from hemorrhagedue to a blood vessel tearing at the time the fetal membranes rupture or during labor and delivery. Another danger is lack of oxygen to the fetus. Vasa previa often occurs with a low-lying placenta (due to scarring of theuterus by a previous miscarriage or a D&C), an unusually formed placenta (a bilobed placenta or succenturiate-lobed placenta), an in-vitro fertilizationpregnancy, and multiple pregnancies (twins, triplets, etc). Vasa previa also may accompany velamentous insertion of the umbilical cord. Vasa previa may not be suspected until the fetal vessel rupture occurs. Reduction in fetal mortality depends on prenatal diagnosis. When vasa previa is found before labor, the baby has a much greater chance of surviving. Vasa previa can be detected during pregnancy as early as the 16th week of pregnancy with use of transvaginal sonography in combination with color Doppler. When vasa previa is diagnosed, C-section before labor begins can save the baby's life. The C-section should be done early enough to avoid an emergency, but late enough to avoid problems associated with prematurity.

What is Vasa Previa?: Vasa previa is a serious pregnancy complication that occurs in an estimated 1 in 2,500 pregnancies. In vasa previa, blood vessels involved in the baby's circulation grow along the membranes in the lower part of the uterus at the cervical opening. When the condition is not detected in advance, the blood vessels can rupture during labor. Causes of Vasa Previa: In a normal pregnancy, the blood vessels of the umbilical cord and the placenta are insulated inside the amniotic sac. In vasa previa, blood vessels are present at the membranes without this protection due to eithervelamentous insertion of the umbilical cord or an abnormally formed multi-lobed placenta. Vasa previa of either type can develop as a complication of placenta previa, or a low-lying placenta, being present or having been present at some point during the pregnancy. A velamentous umbilical cord or multi-lobed placenta that exists higher in the uterus would not necessarily mean vasa previa. Why Vasa Previa Is Dangerous?: When a woman with vasa previa goes into labor and the cervix begins to dilate, the blood vessels present at the cervix can rupture. If this occurs, the baby will experience rapid blood loss and may die before doctors are able to do anything about the situation. When vasa previa is not diagnosed before the onset of labor, the chance of stillbirth may be as high as 95%. Beside outright rupture, the blood vessels crossing the cervix can easily become compressed when the baby drops further down in the pelvis, decreasing the baby's blood supply and causing drops in the heart rate. Diagnosis of Vasa Previa: Vasa previa usually causes no outward symptoms during the pregnancy, but doctors can pick up markers for the condition as early as the second trimester via ultrasound. Following up a standard ultrasound with a color Doppler ultrasound can give doctors a good idea whether vasa previa is present. Risk Factors: Pregnancies involving known placenta previa, velamentous cord insertion, or multi-lobed placenta may be at risk for vasa previa. In addition, multiple pregnancies or pregnancies conceived via IVF are at increased risk. Vasa previa in a previous pregnancy does not appear to be a risk factor.

Treating Vasa Previa: When doctors are able to diagnose vasa previa early in the pregnancy before the onset of labor, mothers may be hospitalized in the third trimester to ensure rapid access to medical care should blood vessels rupture. The doctor will most likely perform a c-section around 35 weeks of pregnancy. This strategy drastically improves the odds that the baby will survive. Early delivery carries some risk to the baby because of normal consequences of prematurity, but the risks are much lower than if the vasa previa is not detected and labor progresses normally.