Vasa praevia:

Definition:
Bloodvessels between umbillical cord and placenta, passing the membranes in an area that will be torn during
the delivery

Cause:
A velamentous insertion of the umbilical cord or an vessel between two parts of a placenta bilobata

Incidence:
About 1:2500 – 6000 births

Consequences:
If not detected in some series 50-95% of the fetuses died during the delivery.

Diagnostic possibilities:
With special extras of a USS (a colour Doppler) it is possible to make these vessels visible. We do not have these
possibilities here in our hospital. In the Netherlands it is NOT a compulsory part of the examination of a
pregnancy.

More risk if:

If in early stage of this pregnancy the placenta was over the os but later withdrew, in multiple pregnancies and
after in vitro fertilization.

Symptoms:
Vaginal blood loss (sometimes just a bit) and it may be regarded as “show”.

Treatment:
If known: early Caesarean Section after pre-treatment with dexamethasone.
Chance of spontaneous rupture of the membranes: between 26 and 34 weeks 1%, between 34 and 37 weeks
1.5%.
As more babies here will die from prematurity than from vasa praevia we will not easily induce labour before a
sure gestational age of 37 + 0 weeks, even if we would know that vasa praevia are present.

Literature used:
Manual of Standard Managements in Obstetrics and Gynaecology for Doctors, H.E.O.s and Nurses in Papua
New Guinea. Sixth edition, 2010
Dutch Association of Obstetricians and Gynaecologists: Guidelines bloodloss in second half of pregnancy 2008

Gert van den Berg, tropical doctor, dept. Of Obstetrics and Gynaecology, Modilon General Hospital, Madang
Gert4/documents/lectures for residents/xxvasa praevia.doc