Vasa previa is a rare but serious pregnancy complication where fetal blood vessels are located in the membranes unprotected by the placenta near the cervix, leaving them vulnerable to rupture during labor, potentially causing life-threatening bleeding for the baby. It usually requires a planned cesarean delivery to prevent this from happening. Our center now offers prenatal laser ablation surgery for selected cases of vasa previa.
Risk Factors
The following conditions increase the likelihood of vasa previa:
- Assisted reproductive technologies (in vitro fertilization)
- Multifetal pregnancies (twins, triplets)
- Low-lying placenta (placenta previa or marginal placental placement)
- Velamentous cord insertion where the umbilical cord attaches to the placenta’s edge instead of the center
- Bilobed placenta or accessory lobe
While these factors increase the risk, vasa previa can also occur in pregnancies without these characteristics.
Symptoms
Vasa previa typically shows no sign of symptoms until labor begins. The first indication may be:
- Vaginal bleeding when the membranes rupture (blood loss from the baby)
- Abnormal fetal heart patterns, signaling distress
If untreated, vasa previa can lead to severe complications including fetal death.
How is Vasa Previa Diagnosed?
Ultrasound technology plays a pivotal role in the diagnosis and management of Vasa Previa. With this condition, early detection is critical.
- Ultrasound: Vasa previa is often diagnosed during a routine anatomy ultrasound between 18 and 20 weeks of pregnancy.
- Transvaginal ultrasound: A detailed imaging method to confirm the diagnosis and monitor the condition.
In some cases, vasa previa resolves as the pregnancy progresses, only requiring follow-up scans to reassess.
Types of Vasa Previa
Vasa previa is classified into three types based on the origin of the unprotected fetal blood vessels. Each type presents unique diagnostic and management considerations, emphasizing the importance of early detection through detailed ultrasound evaluation.
- Type I: Arises directly from a velamentous umbilical cord insertion, where the umbilical cord attaches to the placenta at an abnormal edge or surface instead of the center.
- Type II: Occurs when fetal blood vessels bridge separate lobes of a bilobed or succenturiate placenta (a placenta with additional smaller lobes connected by blood vessels).
- Type III: Represents abnormal fetal blood vessels branching off the placenta that persist after the resolution of placenta previa or a low-lying placenta. This type occurs without the presence of a velamentous cord insertion (Type I) or a multilobed placenta (Type III).
How is Pregnancy with Vasa Previa Managed?
How is Pregnancy with Vasa Previa Managed?
Managing a pregnancy complicated by vasa previa focuses on reducing risks and ensuring the best possible outcome for both the baby and the mother. Two main approaches are utilized—expectant management and active intervention. Both management strategies aim to reduce risks associated with vasa previa and ensure safe delivery. The choice of approach depends on factors such as the type of vasa previa, gestational age, technical feasibility of laser procedure, and availability of specialized care.
Expectant management
Expectant management consists of careful monitoring and preparation to prevent complications. Historically, undiagnosed vasa previa has carried a perinatal mortality rate of 40-50%, mainly due to unrecognized blood vessel rupture and severe fetal blood loss. However, with prenatal diagnosis, this rate can drop to as low as 3%. Key elements of expectant management include:
- Hospitalization: Patients are often hospitalized within the Labor and Delivery unit at the Riley Maternity Tower between 28 and 32 weeks of pregnancy to ensure immediate access to surgical intervention if vessel rupture is suspected.
- Monitoring for bleeding: Approximately one-third of patients may experience vaginal bleeding during pregnancy, requiring timely identification of the source and continuous fetal monitoring to detect signs of distress.
- Corticosteroid therapy: Administered around 28 weeks gestation, corticosteroids help mature the baby’s lungs in preparation for potential early delivery.
- Scheduled delivery: To minimize the risk of vessel rupture, cesarean delivery is typically planned at 34- and 36-weeks gestation, even if there are no signs of gestation.
Active intervention: Fetoscopic laser photocoagulation (FLP)
In select cases, fetoscopic laser photocoagulation (FLP) may be performed to address vasa previa. The procedure involves using a laser to clot the fetal blood vessels that cross the cervix, effectively eliminating the risk of rupture during labor. At Riley Children’s Health, the Fetal Surgery Program is among only a few centers worldwide offering this innovative approach for vasa previa.
- Timing: FLP is generally performed between 30- and 33-weeks gestation.
- Advantages: After a successful procedure, the pregnancy can often continue with routine care, and vaginal delivery may become an option depending on other factors.
- Risks: The risk of this option are those related to operative fetoscopy in general, such as preterm rupture of membranes and preterm labor.
- Recovery: This minimally invasive procedure typically allows for a short hospital stay and close follow-up care.
Highly skilled, personalized care
At Riley Children’s Health, managing pregnancies complicated by vasa previa is a collaborative effort led by a team of specialized fetal care experts. Our team includes:
- Maternal-fetal medicine specialists: Experts in high-risk pregnancies who closely monitor your baby’s health and your well-being throughout the pregnancy.
- Fetal surgeons: Highly skilled professionals experienced in performing innovative procedures such as FLP to treat conditions like vasa previa.
- Neonatologists: Specialists in newborn care who are ready to provide immediate support in our neonatal intensive care unit (NICU).
- Fetal care coordinators and nurses: Compassionate team members who guide and support patients through every step of their journey from diagnosis to delivery.
Key Points to Remember
Key Points to Remember
- Vasa previa is a rare but serious pregnancy complication where fetal blood vessels lie unprotected across or near the cervix. Without intervention, these blood vessels are at risk of rupturing during labor and delivery, potentially causing life-threatening bleeding for the baby.
- Vasa previa is classified into three types based on the origin of the unprotected fetal blood vessels. Each type presents unique diagnostic and management considerations, emphasizing the importance of early detection through detailed ultrasound evaluation.
- Managing a pregnancy complicated by vasa previa focuses on reducing risks and ensuring the best possible outcome for both the baby and the mother. Two main approaches are utilized—expectant management and active intervention.
- At Riley Children’s Health, managing pregnancies complicated by vasa previa is a collaborative effort led by a team of specialized fetal care experts.
Locations
Locations
Locations
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
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