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• W3047793048 abstract "Misdiagnosis and/or mismanagement of vasa previa can result in significant fetal compromise, including death1. Associated factors, such as chorioamniotic membrane separation, might increase this risk. We present a unique case of a woman who had vasa previa due to a velamentous cord insertion and concurrent significant spontaneous chorioamniotic separation. A 28-year-old woman with a singleton pregnancy and history of two prior uncomplicated full-term vaginal deliveries was evaluated at 20 weeks of gestation. The ultrasound scan showed normal fetal anatomy and amniotic fluid, and a posterior and fundal placenta with no accessory lobes. Significant chorioamniotic separation was noted in the anterior wall of the uterus, measuring 10 cm in length and 1.7 cm in width from the anterior uterine wall (Figure 1a). A velamentous cord insertion was observed at the center of the uterus at a distance from the main placental body. The main branches of the umbilical artery reached the placenta from different directions; one artery and the vein ran along the anterosuperior wall of the uterus within the membranes that were detached (Figure 1b), and the other arterial branch ran anteriorly in the lower uterine segment within the membranes, close to the internal cervical os (Figure 1c). On transvaginal ultrasound, a pulsatile vessel of fetal origin was noted within 1 cm from the internal cervical os consistent with vasa previa (Figure 1d). Serial ultrasound examinations and admission at 28 weeks for inpatient observation and management were recommended. On admission, the patient received a course of steroids for lung maturation and magnesium sulfate for neuroprotection, and underwent tocolysis due to contractions noted on examination. Transvaginal ultrasound showed normal cervical length and vasa previa. At 32 weeks, due to the increased frequency and intensity of uterine contractions, repeated use of tocolytics and risk of preterm labor, the decision to deliver was made. During Cesarean section, fetal vessels were noted upon entering the uterine cavity. Delivery was uncomplicated, resulting in a female newborn weighing 2069 g with normal Apgar scores. Macroscopic evaluation of the placenta and membranes was consistent with velamentous cord insertion (Figure 2a) and showed multiple unprotected vessels coursing through the membranes (Figure 2b). There have been no previous reported cases of spontaneous chorioamniotic separation with concurrent vasa previa. Chorioamniotic separation increases significantly the risk of preterm prelabor rupture of membranes and preterm delivery2-4; the concomitant presence of vasa previa increases the risk of severe and acute bleeding and fetal death. Despite the concern regarding perinatal mortality related to vasa previa, there are insufficient data to suggest that inpatient management reduces significantly the risk of adverse outcome5. However, in our case, inpatient management allowed us to monitor the mother's symptoms and continue surveillance for signs of preterm labor, and perform delivery in a timely, uncomplicated manner, thus reducing the risk of a potentially disastrous outcome. This clinical case reinforces the concept that the umbilical cord insertion should always be evaluated during the second-trimester ultrasound scan and transvaginal ultrasound examination should be performed to diagnose or exclude vasa previa. Data sharing is not applicable to this article as no new data were created or analyzed in this study." @default.
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• W3047793048 date "2021-07-01" @default.
• W3047793048 modified "2023-09-24" @default.
• W3047793048 title "Concomitant spontaneous chorioamniotic membrane separation, velamentous cord insertion and vasa previa" @default.
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• W3047793048 doi "https://doi.org/10.1002/uog.22168" @default.
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