Monochorionic Diamniotic Vasa Previa Pregnancy: A Medical St
The patient is a 29-year-old G3P0111 with monochorionic diamniotic twins diagnosed with vasa previa by transvaginal ultrasound at 16-week gestation. Her prior pregnancy was complicated by preterm labor and delivery at 36-week gestation. The current pregnancy was otherwise uneventful, and the plan was for inpatient observation starting at 30 weeks with planned cesarean delivery to avoid labor.

At 29-week gestation, the patient presented with preterm contractions. Betamethasone was administered for fetal organ maturation, and magnesium sulfate was given for neuroprotection. She had persistent preterm contractions with cervical effacement, and therefore, cesarean delivery was indicated. During the low transverse hysterotomy, unprotected umbilical vessels were visualized. Amniotomy was performed while avoiding these vessels, and clear amniotic fluid was noted. Twin male neonates were delivered with Apgar scores 8/8 and birth weights of 1.26kg and 1.33 kg for A and B, respectively. Both twins were evaluated and admitted to the NICU. Cord gases and hemoglobin for both twins were normal.

The remainder of the surgery was uncomplicated. Gross inspection of the placenta and membranes confirmed vasa previa affecting both fetuses. Placental pathology confirmed membranous insertion of the umbilical cord for twin A and twin B. The postpartum course was unremarkable, and NICU courses for infants were typical for gestational age. At the time of this writing, both twins are doing well and meeting appropriate milestones.