Three‐dimensional sonographic diagnosis of vasa previa

Oyelese, Yinka; Chavez, Martin; Yeo, Lami; Giannina, Gregg; Kontopoulos, Eftichia V.; Smulian, John C.; Scorza, William E.

doi:10.1002/uog.1097

Cited by 37 publications

(38 citation statements)

References 8 publications

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“…In the presence of vasa praevia, above the internal cervical orifice, blood vessels will be visible (2). On suspicion of vasa praevia or at high risk to pregnancy (i. e. low placental anchorage, condition after IVF, multiple pregnancies, multisegmental placenta, bleeding from the vagina) or on abdominal ultrasound scan failing to observe a cord attachment point, (1) it is appropriate to perform transvaginal echoscopy with colour doplerometry 2D and 3D (10,12). In the case of vasa praevia detected on transvaginal ultrasound examination, vertically above the internal cervical orifice, a blood flow is clearly visible (12).…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Vasa praevia: a case report and literature review

Norvilaitė

Peštenytė

Bužinskienė

et al. 2016

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Background. The aim of this article is to present a rare clinical case of vasa praevia as well as to assess the relevance of the problem by reviewing the latest literature sources.Materials and methods. In this report we present a case of a 33-yearold woman diagnosed with vasa praevia at 33 weeks of pregnancy, after hospitalisation with preterm rupture of membranes following the delivery of a live healthy baby through a lower segment Caesarean section during 33rd week of gestation at Vilnius University Hospital Santariškių Clinics. We investigated all the documentation of the patient before and after delivery.Results and conclusions. Vasa praevia is a rather rare pathology which is likely to occur during pregnancy, may result in heavy bleeding and be particularly threatening to the fetus life. A timely diagnosis for these women is essential. The gold standard for vasa praevia diagnosis is the fetal ultrasound scan. Vasa praevia pathology is found during the routine second trimester ultrasound check-up. The selection of proper tactics applied during pregnancy care is essential. At the gestational age of 28-32, it is advisable to mature fetal lungs as well as the fetus condition should be investigated by a perinatologist. The mode of delivery is the C-section which tends to reduce the frequency of possible complications.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Vasa praevia: a case report and literature review

Norvilaitė

Peštenytė

Bužinskienė

et al. 2016

AML

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“…Three-dimensional sonographic visualization may help in the future to better define the anatomical relationship between vessels, placenta and the cervix. This will allow communication of more accurate findings to the parents and to the surgeon who will perform the caesarean section [18,19].…”

Section: Diagnosismentioning

confidence: 98%

Vasa praevia: a lethal threat to the fetus

Ameryckx

Amy

2006

Eur Clinics Obstet Gynaecol

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Vasa praevia constitutes a rare obstetric complication that is potentially lethal for the generally healthy infant. If unrecognized antenatally, the condition carries a higher fetal mortality rate than any other complication in pregnancy. Only in the past two decades have major diagnostic advances led to a dramatic improvement of perinatal survival and lower morbidity rates. Good outcomes depend primarily on prenatal diagnosis and appropriate management. The performance of a caesarean section before rupture of the membranes and the onset of labour is mandatory. Simple modifications of standard screening protocols and the recognition of high-risk patients will allow identification of most cases of vasa praevia. DefinitionIn normal circumstances, the umbilical cord is inserted into the chorionic plate (fetal surface) of the placenta (central or, more frequently, eccentric insertion) or on the placental edge (marginal insertion). The umbilical cord vessels course over the fetal surface before entering the placenta. In about 1% of singleton and 10% of twin pregnancies, however, the umbilical cord vessels separate from each other and start branching at a distance from the placental margin; they run through the membranes, surrounded only by a fold of amnion, before reaching the chorionic plate. If this so-called velamentous insertion is situated in the lower uterine segment, and the unprotected fetal vessels cross the region of the internal cervical os below the presenting fetal part, one speaks of vasa praevia. This aberrant vasculature can also be associated with bilobed or succenturiate placentas, in which case the vessels run between the accessory lobes.Vasa praevia is encountered rarely (1 of 2,500-5,000 deliveries), but even today they are associated with high fetal mortality (∼60%) and morbidity if undiagnosed antenatally [1]. The unprotected umbilical vessels are exposed to compression or rupture, especially during labour or at the time of rupture of the membranes. Laceration of the vasa praevia can rapidly lead to fetal exsanguination, shock (after as little as 60-ml blood loss, corresponding to 20-25% of the feto-placental blood volume) and intrauterine death. The fetus, indeed, has only a small circulatory volume of 80-100 ml/kg. The mother, on the other hand, is not at risk, in contrast to haemorrhages resulting from placenta praevia or abruptio placentae. AetiologySome placentas implant over the uterine isthmus or even over the internal cervical os. Due to the development of the lower uterine segment during the third trimester, the placenta appears to "move away" from the cervical region. The placenta preferentially grows in the better vascularised area of the corpus and may undergo atrophy in the lower parts of the uterus [2]. During this process, an aberrant vessel can persist over or close to the cervix. In cases where the placenta overlies the less vascularised internal os, it may undergo atrophy, which results in the development of a succenturiate lobe and connecting vasa praevia. Beside the aforement...

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“…If the vessels persist on multiple examinations and do not move with maternal change in position, especially placing the patient in a trendelenburg position, this confirms the diagnosis of vasa previa. Three-dimensional sonography, especially with colour, power and pulsed wave Doppler is useful in displaying spatial relationships between the vessels and the cervix, and may help confirm the diagnosis [31][32][33] . The diagnosis should always be confirmed by examination of the placenta after delivery (Fig.…”

Section: Diagnosis Of Vasa Previamentioning

confidence: 99%