Vasa previa is a rarely (1:3000) reported condition in which one or more fetal blood vessels from the placenta or umbilical cord cross the entrance to the birth canal, beneath the baby and just close to the inside of the cervix. The condition has a high fetal mortality rate (50-95%). This can be attributed to rapid fetal exsanguination resulting from the vessels tearing when the cervix dilates, membranes rupture or if the vessels become pinched off as they are compressed between the baby and the walls of the birth canal.

Risk Factors:

• Low-lying placenta or placenta previa
• Bilobed or succenturiate-lobed placenta
• Velamentous insertion of the cord
• In-vitro fertilization pregnancies
• Multiple pregnancies
• History of uterine surgery or D&C
• Painless bleeding

Diagnostic Testing:

• Transvaginal color Doppler ultrasound for women with above risk factors
• Document normal central umbilical cord placental insertion during all routine obstetrical ultrasounds

Management:

• Pelvic rest
• Hospitalization in the 3rd trimester
• Delivery by C-section at 35 weeks
• Immediate blood transfusion and aggressive resuscitation of the infant in the event of a rupture