Vasa Praevia:
The presentation, in front of the fetal head, during labour, of the blood vessels of the umbilical cord, where they enter the placenta in a velamentous insertion. The blood vessels are situated over the cervical os. In some cases, vasa praevia is present due to a succenturiate lobe, rather than velamentous insertion. When the membranes rupture, bleeding from these vessels may occur, causing severe fetal distress and possibly fetal death, if not delivered promptly (Tiran, 2003). It is rare, but disastrous if not prenatally diagnosed. Incidence: 1 per 6,000 deliveries. Delivery by caesarean section is imperative, before onset of labour is diagnosed antenatally.

Diagnosis:
The presence of the blood vessel may be suspected on vaginal examination, when the membranes are still intact. If a careful speculum examination were performed with a good light, it might be possible to see the vessel (Medforth, Battersby, Evans, Marsh and Walker, 2006).

Signs and Symptoms:
Minimal fresh loss, occurring typically on rupture of membranes.
On monitoring the fetal heart, there are signs of fetal compromise, disproportionate to the amount of blood loss seen.
There may be a sinusoidal fetal heart pattern seen when the fetus is severely anaemic.

Risk factors:
Velamentous insertion.
Succenturiate lobe / bilobed placenta.
Low-lying placenta / placenta praeva.
Painless bleeding at any time in pregnancy.
IVF pregnancies.
Multiple pregnancies.
History of previous uterine surgery.

Velamentous insertion

Bilobed placenta


Medforth, J., Battersby, S., Evans, M., Marsh, B. and Walker, A. (2006) Oxford Handbook of Midwifery. Oxford: Oxford University Press.
Tiran, D. (2003) Baillière’s Midwives’ Dictionary. 10th ed. Edinburgh: Baillière Tindall.

Further Resources:
www.vasapraevia.co.uk/
www.vasaprevia.org/

I always have that picture of a velamentous insertion in mind when I do an ARM. Scary ****.

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I was diagnosed with velementous insertion with ds #2, very scary ****. I had gone in at 20 weeks with a LOT of bleeding and there were five doctors that confirmed it on the ultrasound. So, they put me on strict bedrest and when I was 24 weeks, gave me shots of surfectant expecting to deliver very premature via c/section. Turned out, next ultrasound showed insertion just fine. In the end, delivered two weeks early vaginally, induced. Had a bilobed placenta, with the lobe being the same size, and I think everybody on the floor came in to see cause it was such a novelty, heehee.

Still, up until they told me that the insertion was fine, I was scared to death that I'd lose my baby and even my own life. They did say that it's actually rare to have it diagnosed before delivery, so they felt lucky. Very scary, though.

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Sasha, Doula, Mama, Wife, Student Midwife

Three little wild boys and one soldier husband

They gave you surfactant??????? Wow thats mad, its the most expensive drug and its not routinely given to prems!!! We give steroids, betamethasone, then surfactant if they need it at birth-dependant on gestation etc..

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seems pretty routine here. It's about the most painful shot I've ever had, and of course I had to have it more than once.

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Sasha, Doula, Mama, Wife, Student Midwife

Three little wild boys and one soldier husband

Checked as accurate - K(RM)

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Love Dory xxx
Just keep swimmin', just keep swimmin'....

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