Clinical Presentations, Outcomes and Implications

 Evaluate patients with diagnosis of vasa previa and assess outcomes in order to develop recommendations

 32yo G3P2002 with Di-Di twins and h/o 2 prior c/s  Twin A initially noted to have velamentous CI, no vasa previa at 20wga  Presented with VB at 25w5d.  Developed/Identified as placenta previa with velamentous CI and vasa previa at 25w6  d/c’ed, returned with 2 nd bleed at 26w3d, signed out AMA HD#8  Presented in labor at 32w2d, 2-3cm visually dilated with bulging membranes

Pathologic Diagnosis : A. Twin placenta: -Third trimester dichorionic diamniotic twin placenta: -Twin #1 placenta showing intervillous hemorrhage, acute chorioamnionitis and velamentous insertion of cord. -Twin #2 placenta showing velamentous insertion of cord.

 20w US : complete previa with marginal cord insertion  Progressed to marginal placenta previa with velamentous cord insertion and vasa previa  Plan to admit at 32wga (tomorrow)  Plan for delivery at 34wga

 33yo G1P0 with anterior placenta, posterior succenturate lobe, marginal placenta previa, vasa previa.  Admitted at 32wga for surveillance  Plan for delivery between 34 and 35 wga

 41yo G1P0 with vasa previa, low lying placenta, marginal, possible velamentous C  Admit at 32w2d  Scheduled delivery at 34 WGA