Vasa Praevia - Are You At Risk?
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Thread: Vasa Praevia - Are You At Risk?

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    Posting Addict Uropachild's Avatar
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    Default 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:
    • 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).
    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.

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

    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,
    • 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
    I get all my info from www.vasapraevia.co.uk (UK site) and www.vasaprevia.com (US site).

    Any questions?
    Last edited by Uropachild; 04-12-2010 at 05:46 PM.
    Sarah
    Korben, 12 months
    Lyric, 34 months
    Ada, born sleeping, Sept 2007
    Zane, one day on earth, October 2006

    http://family-nelson.blogspot.com

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    Prolific Poster KittyRN's Avatar
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    Wow this is great info!!!! I will definitely be mentioning it to my OB my next appointment since I had that bleed this am.

    I'm so sorry you had to go through that but I'm glad you are taking that sad experience and helping others avoid it.
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    Posting Addict ange84's Avatar
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    I will have to ask my doctor about this because I have had spotting going since about week 9 and at my emergency 12 week scan they noticed my placenta was low. They showed me the cord and I think it was in the middle but i will ask to be double checked at my 20 week scan if they are able to do it here (small town) if not I will ask to be referred to the next town where they have better equipment. Thanks you for the information.
    Wendy




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    Super Poster ToriBella's Avatar
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    Thank you for all the information! I am so sorry that you had to suffer through this, but I am so grateful that you are using your experience to educate others. It takes a strong person to be able to do that, and you are undoubtibly strong.

    I do have a question. If you fall into only one of these categories, does that put you at risk? Or is it when you are in, for example, 2 or more? I've had a few bouts of painless bleeding early on, but nothing since then. The doctor hadn't told me if my placenta was in the wrong place or anything, and I'm sure she would have if something was up, right?
    Tori and Kent 26.6.2011 <3
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    Posting Addict laurensmitty1982's Avatar
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    So if you have had previous c/s will they be able to tell this at your 20 week apt? Ive had 2 prior and just wondering if this is something they can see when they do your u/s?
    Mom of 3 beautiful babes!
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    Thanks for all the info Sarah. It makes me realize that I was at high risk for that when pregnant with Oli...like I needed any other risk. I had a trilobed placenta, and one of the lobe was very low lying (mm from the cervix). AND I probably had a vanishing twin with him as there has been a twin to twin transfusion (placenta to placenta, really) and the lobe without a baby attached to it bled in my amniotic liquid.

    I'll make sure to get checked closely for vasa praevia if I have a multilobed placenta this time too.
    Carole

    mommy to Kelly-Anne oct. 01, Raphael dec. 03, Nicolas Sept. 07 and baby Magalie Sept. 10


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    Posting Addict faeriecurls's Avatar
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    *lurker*

    Thanks for all of this information! I was just told I had a marginal placenta previa at my 20 week scan this morning. I have a mid-wife appointment tomorrow - I will definitely talk with her about this.

    I am so sorry you had to go through this, but thank you so much for educating people about this.
    Erica
    DD 9/3/2010



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    Posting Addict SaucyVidel's Avatar
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    I am always surprised when you mention you weren't routinely scanned for it - I've had ultrasounds of varying levels at different places for three pregnancies now and they ALWAYS scan for the blood vessel distribution and cord insertion on both sides. I asked my ultrasound tech about it at my NT scan and he says that in the US, at least, it is a routine screening in both the NT scan and the 20 week biophysical profile.

    Either way, it is great you pass on the information another this condition, as it is so tragic, but fortunately the obstetrical community seems to be erring more and more on the side of caution with placental issues in this country, at the very least.
    Taryl

    DD1: 4/07
    DD2: 7/08
    DS1: 10/10/10

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    Posting Addict Uropachild's Avatar
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    Didn't want to read and run... It's not even 6am yet here and i have a looooong day at work ahead of me. I'll come back to this tonight when Lyric is tucked up in bed and i have the proper time to give it.
    Sarah
    Korben, 12 months
    Lyric, 34 months
    Ada, born sleeping, Sept 2007
    Zane, one day on earth, October 2006

    http://family-nelson.blogspot.com

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    I have to say that with my 3 boys I don't remember them scanning for this. I can tell you that last week at my First Screening, they did check for it and showed the blood flow. It was neat to see that.
    Sarah, I followed your story back around the time you started posting about them and literally had no words. You are such a strong woman and I'm sure that all the information you are posting is helping many other women. You are such an inspiration and I totally admire you. You rock Mama!
    Dan and Leah
    Married 5-17-97
    DS Daniel 4-26-00
    DS Joshua 8-16-02
    DS Leo 3-6-07
    DS James 9-29-10

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