Diagnosis and management of vasa previa: NEJM case report
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A 37-year-old woman presented to the obstetrical clinic for routine fetal ultrasonography at 27 weeks of gestation. Vaginal ultrasonography revealed a low-lying posterior placenta and velamentous cord insertion (i.e., rather than being inserted centrally on the placenta, the umbilical cord was affixed to the fetal membranes and tracked the surface of the membranes to the placenta).

Transvaginal color Doppler ultrasonography revealed fetal blood vessels covering the internal cervical os, a finding consistent with vasa previa (Panel A; red arrow denotes the fetal head, blue arrow blood vessels, and violet arrow the cervical canal). Vasa previa is a condition in which fetal blood vessels are within 2 cm of the internal cervical os or traverse it without protection from the placenta or Wharton’s jelly.

These unprotected fetal blood vessels are at a high risk for rupture during labor and vaginal delivery; cesarean delivery before rupture of the membranes is indicated. The patient underwent a scheduled cesarean delivery at 34 weeks of gestation.

A low, transverse uterine incision revealed an intact amniotic membrane with fetal blood vessels crossing over the membrane that covered the head of the fetus (Panel B). Examination of the placenta revealed membranous vessels that merged to form the umbilical cord, confirming the presence of velamentous cord insertion (Panel C).

The infant had transient tachypnea of the newborn but recovered well, and both mother and baby were ultimately discharged home.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1808778
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