VASAPREVIA and VELAMENTOUS PLACENTA
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Free template from www.brainybetty.com Obstetric emergency Complication of labour Major cause of antepartum hemorrhage Refers to anomalies of umbilical cord 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Velamentous placenta Incidence: 1% - singleton pregnancies, 8.7% - twin pregnancies, higher in early pregnancy & spontaneous abortion. Normally: Umbilical cord usually inserts on placental mass - 99% cases. Velamentous placenta - cord inserted on chorioamniotic membrane. Variable amount of cord unprotected by Wharton’s jelly. Vasa praevia coexisting in 6% singleton pregnancies with velamentous insertion. 11/1/2017 Free template from www.brainybetty.com
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Definition of vasa previa Fetal vessels crossing or running in close proximity to the inner cervical os. These vessels course within the membranes (unsupported by the umbilical cord or placental tissue) and are at a risk of rupture when the supporting membranes rupture. 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Pathology Unknown Phototropism - Lower segment not nourishing - placenta grows upwards to reach more nourishing tissue. 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Risk factors Low lying placenta Placenta previa Multiple pregnancies Multilobate placenta Velamentous insertion Multifetal pregnancy Placenta membranacea Invitro fertilization 11/1/2017 Free template from www.brainybetty.com
Symptoms of Velamentous placenta Asymptomatic Sudden onset of painless bleeding in 2nd or 3rd trimester or at artificial or spontaneous rupture of membranes Heavy or small amount of bleeding. No sign symptom of Placenta praevia or abruption. Signs IUGR/ Congenital malformation 11/1/2017 Free template from www.brainybetty.com
Clinical Features of vasa previa Vaginal bleeding IS THE ONLY SYMPTOM Diagnostic measures Digital palpation of vasa previa Amnioscopy Fetal blood detection USG MRI Fresh bleeding per vagina 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Management Immediate consultation Assess the presenting part Fetal heart rate During first stage: Fetus is alive Caesarean section During second stage: watch for spontaneous delivery Vaginal birth 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Care of the newborn Presence of the pediatrician Hemoglobin estimation Resuscitation Blood transfusion 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Associated anomalies Cephalocele Trisomy Heart rate anomalies Small for gestational age Intraventricular hemorrhage Intrauterine fetal death 11/1/2017 Free template from www.brainybetty.com
Free template from www.brainybetty.com Prognosis Rupture of vessels Median Apgar score Transfusion Compressed vasaprevia Postnatal complications Hyaline membrane disease Bronchopulmonary dysplasia Transient tachypnea Respiratory disease syndrome 11/1/2017 Free template from www.brainybetty.com