- Updated guidelines addressing vasa previa management have been published by the Royal College of Obstetricians and Gynaecologists.
Why this matters
- Vasa previa occurs when the fetal vessels run through the placental membranes, increasing risk for fetal exsanguination following rupture of membranes in active labor or with amniotomy.
- Vasa previa is rare (1 in 1200 to 1 in 5000 pregnancies) but life-threatening (at least 60% fetal mortality after rupture of placental membranes).
- Routine fetal anatomy ultrasound has a high diagnostic accuracy and low false-positive rate in diagnosis of vasa previa.
- A combination of both transabdominal and transvaginal color Doppler imaging provides the best diagnostic accuracy.
- Evidence is unsufficient to support universal screening.
- In the presence of vasa previa in the third trimester, elective cesarean delivery should be carried out prior to the onset of labor.
- In the presence of vasa previa and preterm premature rupture of membranes and or preterm labor, a cesarean section should be immediately performed.
- Planned delivery at 34-36 gestational weeks is reasonable in asymptomatic women.
- Corticosteroids should be considered from 32 weeks.
- Literature review and expert commentary.
- Funding: None disclosed.
- Related to limitations of prior research.