Vasa Praevia - Are You At Risk?
I thought i'd start a new thread, since there will likely be a few women here who fall into the risk categories for this. I'm just going to copy and paste my reply to Kelly on my other thread (because i'm lazy) and then add to it as i think of things...
Perhaps we could use this thread to discuss your concerns or ask questions? PM me if you feel more comfortable. I'm not a doctor by any stretch, but i can point you in the right direction if you may be at risk.
Please don't take this lightly - knowledge is power here and is the one single thing that could save your baby's life. I would give anything to go back in time and give myself the gift of knowledge of this condition.
I don't want to scare you. I just want your babies to live. I know of two or three internet friends who had had this condition and one woman who lives down my mums street who had it twice. Not to mention the hundreds of members of the yahoo group who have either been lucky enough to receive a diagnosis, or unfortunate enough to have lost a child because of it. It happens. More than you think.
Okay, here are the basics:
This is what it looks like.
Vasa Praevia is a very managable condition. When a prenatal diagnosis is obtained the survival rate for baby is 100%. When no diagnosis is obtained the MORTALITY rate is 95%. I was one of the unfortunate ones and had no idea.
I had a couple of massive bleeds at 41 weeks pregnant and after a crash c-section and 36 hours of special care with a couple of blood transfusions our little boy died because of the blood loss.
You see, because the blood vessels are running close to or over the cervix and through the membranes, when the membranes break, those blood vessels break and a baby looses it's blood supply in seconds. So a woman with Vasa Praevia cannot be allowed to go into labour. Not just because of the risk of membrane rupture, but also because each contraction pushes the presenting part of the baby down onto the vessels, cutting off blood supply.
Here are the risk groups:
In my case i had a low laying placenta at my 20 week scan and (unbeknownst to me) i must have had a marginal insertion of the cord on the lower edge of the placenta. I was rescanned at 35 weeks and since my placenta had "moved" they told me all was okay. Actually i had turned into a ticking time bomb.
- Low-lying placenta or placenta previa (even if it moves - mine did)
- Bilobed or succenturiate-lobed placenta
- Velamentous insertion of the cord (cord running through membranes and then into placenta)
- In-vitro fertilization pregnancies (highest risk at 1 in 300 pregnancies)
- Multiple pregnancies
- History of uterine surgery or D&C
- Painless bleeding (at any stage of pregnancy)
- Marginal insertion of the cord on the lower edge of the placenta (this isn't on the list on the website for some reason, but is something they look for when screening for it).
What really happens is that your placenta doesn't move at all. In fact, it kind of grows a little at a time on the top edge as your uterus expands upwards and at the same time the lower edge disintegrates. This is fine if your baby's cord is inserted in the middle, or towards the top edge - the cord gets swept up with the placenta. If the cord is inserted on the lower edge (like mine was), as the placenta disintegrates on the bottom edge it actually leaves the fetal blood vessels exposed and running through membranes instead of being directly "plugged in". This is soooo fragile. Like i said before, once membranes break fetal blood is lost in seconds. A full term baby only has about as much blood as what's in a can of coke!
The good news is that the survival rate is 100% with a diagnosis and correct management. Management includes hospitalisation and bedrest from 28 weeks with a c-section delivery at 35 weeks. It's early because you just cannot afford to go into labour at all.
To screen for the condition:
At my NT scan on Saturday i was screened for Vasa Praevia. They look for all the above risk factors and the insertion of the cord. This time baby's cord is inserted towards the top edge of the placenta. (yey!)
- Transvaginal color Doppler ultrasound for women with above risk factors
- Document normal central umbilical cord placental insertion during all routine obstetrical ultrasounds
I will be scanned again later on since i fall into a risk group just by having had c-sections. This is when they will do a transvaginal colour doppler ultrasound scan. I am uncertain when is the earliest they can do this scan, but i had mine at 24 weeks last time. During this scan they use the internal probe to do a transvaginal colour doppler ultrasound scan. The probe looks directly onto the cervix, giving the best possible picture of what lurks there. The colour doppler is where they switch on the blood flow imaging - blue and red - you might have seen it before. They use it a lot, so as you know the technology is already there, they just need to use it. This will give you a diagnosis. If blood vessels are covering or near to the cervix you have Vasa Praevia.
As i said before, correct management of the condition is key,
I get all my info from www.vasapraevia.co.uk (UK site) and www.vasaprevia.com (US site).
- Pelvic rest
- Hospitalization in the 3<sup>rd</sup> trimester
- Delivery by C-section at 35 weeks
- Immediate blood transfusion and aggressive resuscitation of the infant in the event of a rupture
Any questions? :D