Toward a new standard for assessment of suspected vasa previa

Abstract

In a recent publication 1 , Pozzoni et al. reviewed the diagnosis and outcome of Type-III vasa previa (VP), which is an emerging issue. Since more than 15% of Type-III VP cases did not show antenatal risk factors that could facilitate a diagnosis (e.g. abnormality of placental position or shape), the authors recommended universal VP screening between the first and second trimester. Nonetheless, we believe that some elements require further investigation. Firstly, although universal VP screening remains debated, around 85% of cases of Type-III VP are associated with placental abnormalities, especially mid-trimester low-lying placenta and marginal cord insertion 1,2 . Secondly, numerous pitfalls can make diagnosis difficult or cause it to be missed, including the traditional method of evaluation by manual lifting of the fetal head from the internal cervical os, which can be misleading 3 . Thirdly, placental tissue atrophy, possibly due to reduced vascular flow in the lower uterine segment, which is the most popular pathogenetic hypothesis of Type-III VP, has not yet been confirmed 1,4 . In regard to this scenario, we discuss the case of a patient who was admitted recently to our institution (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy) which summarizes these clinical challenges well, allowing us to formulate a proposal for a standard multi-step evaluation of patients with suspected Type-III