Vasa previa – What are the signs and symptoms, relevant dDx., sequelae, work up, and treatment options?

Vasa previa occurs when unprotected fetal vessels pass over the cervical os, and is associated with velamentous insertion of the cord into membranes of the placenta or succenturiate lobe.

Sn. & Sx.:

• Painless vaginal bleeding
• Fetal distress (tachy- or bradyarrythmia)

dDx.:

• Implantation of placenta
• Placental abruptione
• Placenta previa
• Abortion (threatened, inevitable, incomplete, complete)
• Abnormal pregnancy (ectopic, molar)
• Trauma (post-coital, following pelvic exam)
• Genital lesions (cervical polyp, neoplasm)

Sequelae:

• Fetal demise

Work up:

• Apt test (determine whether source of bleeding is fetal or maternal)
• Wright stain (nucleated red blood cells indicate cord)

Tx.:

• Emergency C-section

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This post was written by Omar Rifai