Vasa previa Archives - Revista Brasileira de Ginecologia e Obstetrícia
, Summary
Rev Bras Ginecol Obstet. 2019;41(5):348-351
, Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-yearold primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.
Summary
Rev Bras Ginecol Obstet. 2019;41(5):348-351
, Vasa previa (VP) is a dangerous obstetric condition associated with perinatal mortality and morbidity. In vitro fertilization (IVF) is a risk factor for VP due to the high incidence of abnormal placentation. The diagnosis should be made prenatally, because fetal mortality can be extremely high. We report two cases to demonstrate the accuracy of transvaginal ultrasound in the prenatal diagnosis of VP. A 40-year-old primiparous Caucasian woman with IVF pregnancy was diagnosed with VP at 29 weeks of gestation and was hospitalized for observation at 31 weeks of gestation. She delivered a male newborn weighing 2,380 g, with an Apgar score of 10 at 5 minutes, by elective cesarean section at 34 weeks + 4 days of gestation, without complications. A 36-yearold primiparous Caucasian woman with IVF pregnancy was diagnosed with placenta previa, bilobed placenta increta and VP. The cord insertion was velamentous. She was hospitalized for observation at 26 weeks of gestation. She delivered a female newborn weighing 2,140 g, with an Apgar score of 9 at 5 minutes, by emergency cesarean section at 33 weeks + 4 days of gestation due to vaginal bleeding. The prenatal diagnosis of VP was associated with a favorable outcome in the two cases, supporting previous observations that IVF is a risk factor for VP and that all IVF pregnancies should be screened by transvaginal ultrasound.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):465-468
DOI 10.1590/S0100-72032001000700009
The differential diagnosis of hemorrhages during the third trimester of pregnancy due exclusively to obstetrical causes includes: abruptio placentae, low insertion of placenta (placenta previa with subtypes), rupture of the uterus, rupture of the marginal placental sinus and rupture of the vasa previa. The three first diagnoses occur more frequently, their epidemiological factors are better known and therefore, have an easier diagnosis. It is common for obstetricians with long practical experience, as well as for ultrasonographers specialized in fetal medicine and who thoroughly know their theory, not to have ever been exposed to practical obstetrical cases of vasa previa or their rupture. The reason to write this article was the fact that, during the past 32 years, we have been working constantly and uninterruptedly in obstetrical practice and we have seen only one case of rupture of vasa previa during labor, which killed the fetus. Initially, we investigated the issue in obstetrical textbooks having no luck whatsoever, except for a couple of lines on the subject. Carrying out our search in depth, we were able to learn that, even though a rarity, today's literature on the subject suggests that it is possible to have a diagnosis for this morbid entity during gestation, and to solve the problem by making the cesarian section mandatory in these cases, leading to a significant reduction in the actual fetal mortality figures which, according to experts, vary between 33 and 100%.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):465-468
DOI 10.1590/S0100-72032001000700009
The differential diagnosis of hemorrhages during the third trimester of pregnancy due exclusively to obstetrical causes includes: abruptio placentae, low insertion of placenta (placenta previa with subtypes), rupture of the uterus, rupture of the marginal placental sinus and rupture of the vasa previa. The three first diagnoses occur more frequently, their epidemiological factors are better known and therefore, have an easier diagnosis. It is common for obstetricians with long practical experience, as well as for ultrasonographers specialized in fetal medicine and who thoroughly know their theory, not to have ever been exposed to practical obstetrical cases of vasa previa or their rupture. The reason to write this article was the fact that, during the past 32 years, we have been working constantly and uninterruptedly in obstetrical practice and we have seen only one case of rupture of vasa previa during labor, which killed the fetus. Initially, we investigated the issue in obstetrical textbooks having no luck whatsoever, except for a couple of lines on the subject. Carrying out our search in depth, we were able to learn that, even though a rarity, today's literature on the subject suggests that it is possible to have a diagnosis for this morbid entity during gestation, and to solve the problem by making the cesarian section mandatory in these cases, leading to a significant reduction in the actual fetal mortality figures which, according to experts, vary between 33 and 100%.
