Placental Types and Effective Perinatal Management of Vasa Previa: Lessons from 55 Cases in a Single Institution

Background: We aimed to identify clinical characteristics and outcomes for each placental type of vasa previa (VP). Methods: Placental types of vasa previa were defined as follows: Type 1, vasa previa with velamentous cord insertion and non-type 1, vasa previa with a multilobed or succenturiate placenta and vasa previa with vessels branching out from the placental surface and returning to the placental cotyledons. Results: A total of 55 cases of vasa previa were included in this study, with 35 cases of type 1 and 20 cases of non-type 1. Vasa previa with type 1 showed a significantly higher association with assisted reproductive technology, compared with non-type 1 (p = 0.024, 60.0% and 25.0%, respectively). The diagnosis was significantly earlier in the type 1 group than in the non-Type 1 group (p = 0.027, 21.4 weeks and 28.6 weeks, respectively). Moreover, the Ward technique for anterior placentation to avoid injury of the placenta and/or fetal vessels was more frequently required in non-type 1 cases (p < 0.001, 60.0%, compared with 14.3% for type 1). Conclusion: The concept of defining placental types of vasa previa will provide useful information for the screening of this serious complication, improve its clinical management and operative strategy, and achieve more preferable perinatal outcomes.

Clinical case of delivery of a pregnant woman with Vasa previa on the background of Placenta previa/accreta

Vasa previa is characterized by the presentation of blood vessels of the umbilical cord, which pass through the amniotic sac over the inner eye of the cervix or in its immediate vicinity (up to 5 cm) and are associated with umbilical cord blood flow and are in front of the anterior part of the fetus.Risk factors for Vasa Previa are placental pathology, in particular placenta previa and low placental location; membranous attachment of the umbilical cord, IVF, the presence of an additional share of the placenta or dichotomous placenta, as well as multiple pregnancy. Without prior diagnosis of Vasa previa, fetal mortality reaches 44%, while in antenatal detection the survival rate is up to 97%.Current standard clinical practice during pregnancy with obstetric risk factors for Vasa previa includes assessment of the condition of the lower segment of the uterus and cervix using TVUS and enhanced / color Doppler imaging. The use of additional modern diagnostic methods is a very important step in the aspect of differential diagnosis, especially when additional structures are visualized in the immediate vicinity of the cervix.The article describes a clinical case of Vasa previa on the background of Placenta previa / accreta in women with a burdened somatic and obstetric history and with 4 previous surgeries on the pelvic organs (laparotomy). The management of a clinical case with timely diagnosis and delivery with the help of modern medical and technical support of cesarean section (tranexamic acid, carbetocin, argon plasma tissue coagulation) is presented. Pathology and histology data confirming the diagnosis are attached as well.Thanks to the use of modern methods of diagnosis and delivery, it was possible to prevent severe complications, primarily hemorrhagic, both from the fetus and from the pregnant woman with a rather rare obstetric pathology in the form of Vasa previa with umbilical cord membranous attachment, Placenta previa / accreta partialis.