Vasa Praevia - Are You At Risk?

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Uropachild's picture
Joined: 08/09/05
Posts: 1176
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)
  • [FONT=Verdana]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).
    [/FONT]

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.
[FONT=Verdana]
To screen for the condition:
[/FONT]

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

[FONT=Verdana]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 [FONT=Verdana]covering or near to the cervix you have Vasa Praevia.

As i said before, correct management of the condition is key,
[/FONT][/FONT]

  • 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

[FONT=Verdana][FONT=Verdana]I get all my info from www.vasapraevia.co.uk (UK site) and www.vasaprevia.com (US site).

Any questions? Biggrin[/FONT][/FONT]

KittyRN's picture
Joined: 02/03/09
Posts: 1260

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.

ange84's picture
Joined: 12/28/09
Posts: 6564

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.

ToriBella's picture
Joined: 02/12/10
Posts: 17

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?

laurensmitty1982's picture
Joined: 07/30/06
Posts: 1117

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?

Joined: 04/15/03
Posts: 22

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.

faeriecurls's picture
Joined: 06/04/08
Posts: 790

*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.

SaucyVidel's picture
Joined: 07/20/06
Posts: 634

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.

Uropachild's picture
Joined: 08/09/05
Posts: 1176

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. Smile

Joined: 12/18/08
Posts: 3

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!

BuckeyeK's picture
Joined: 10/23/06
Posts: 3087

That is good info - thanks for sharing!

So sorry for the loss of your son Sad I can't even imagine, especially knowing that it would have been entirely preventable.

KatieWantsABaby's picture
Joined: 06/19/07
Posts: 229

Sarah, thank you so so much for posting this information. My heart goes out to you for the loss of your son, especially knowing it was entirely preventable. It's amazing that you are able to take such a tragedy and use the opportunity to educate those around you about this truly terrible condition.

I seem to remember the tech turning on the color blood flow monitor during my 20-week scan with Ethan, so maybe that's why?

I know that they used the color monitor to check for any kind of heartbeat during my m/c in December (just to be absolutely sure that there wasn't one).

rubber_da_glove's picture
Joined: 12/31/07
Posts: 1527

Your so lovely Sarah :giveflower:

Newlywed630's picture
Joined: 07/20/07
Posts: 770

Sarah, your such a amazing person to take this and help others. Thank you so much.

Am I at risk? I have had 1 c/s and 1 d and c. At my 20 week scan with Trevor the u/s tech turned on color and looked things for a very long time. Would this be one of the things she was looking for?

TyrantOfTheWeek's picture
Joined: 12/26/05
Posts: 1147

:lurk:

Since when are you prego again!!! I quit stalking and look what happens...

Awesome news!!

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"KittyRN" wrote:

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.

I'm soooo late back to this! Did you mention it? What did they say? Have you had anymore bleeding?

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"ange84" wrote:

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.

Yeah, definitely get it double checked - just in case. Smile

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"ToriBella" wrote:

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?

You only need fall into one of the categories for it to be worth a scan to rule out Vasa Praevia. Since you're still very early on, you will be able to find out at your 20 week scan if you need to do any further investigation. Basically, if your placenta is high up, not bilobed etc. and the cord is inserted in the middle or top end you will be fine and no further scanning is required.

However, if you were carrying an IVF pregnancy or twins then you would probably need a transvaginal colour doppler ultrasound scan anyway, because those things in themselves present the risk - iykwim?

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"laurensmitty1982" wrote:

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?

At your 20 week scan they should be able to scan you for other risk factors, like i mentiond above. If your placenta is normal and in a nice high place and the cord is inserted middle or top then you should be fine. I think the risk with previous uterine surgery (CS/D&C etc.) is that it can cause the placenta to implant abnormally - lower etc. I could be wrong on this though, so if in doubt check the websites in my first post. Smile

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"kellmommy01" wrote:

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.

Wow! It sounds like you had a really worrying pregnancy! I have everything crossed that your placenta is nice and normal this time. Do you know yet?

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"faeriecurls" wrote:

*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.

Hi, did you speak to your midwife? What did she say? Smile

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"SaucyVidel" wrote:

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.

Yeah, i think the US is a bit more forthcoming with the screening for this. In the UK we have the NHS of course and because money is sooooooo tight, if they can't make the ££ stack up then they don't do it. They basically say that it doesn't happen enough to bother routinely scanning - so basically the deaths are at an acceptable level. BUT, the data they look at to get this infomration from is flawed. They look at death certificates only, when a lot of Vasa Praevia babies are stillborn. Plus, a Vasa Praevia diagnosis is rarely given in time for making out the death certificate. Zane's certificate lists 4 things, none of which is Vasa Praevia, so it's like he didn't die of that as far as statistics are concerned when in fact he did - the brief we received 3 months later told us he did. It's exasperating to say the least!!!

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"mommieleah" wrote:

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!

I'm so glad they checked you for Vasa Praevia this time, that's fab! xxx

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"BuckeyeK" wrote:

That is good info - thanks for sharing!

So sorry for the loss of your son Sad I can't even imagine, especially knowing that it would have been entirely preventable.

Thanks hun. xxx

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"KatieWantsABaby" wrote:

Sarah, thank you so so much for posting this information. My heart goes out to you for the loss of your son, especially knowing it was entirely preventable. It's amazing that you are able to take such a tragedy and use the opportunity to educate those around you about this truly terrible condition.

I seem to remember the tech turning on the color blood flow monitor during my 20-week scan with Ethan, so maybe that's why?

I know that they used the color monitor to check for any kind of heartbeat during my m/c in December (just to be absolutely sure that there wasn't one).

Yeah, it could have been for the cord insertion. They also use the blood flow check to look at the heart etc., as you sadly know.

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"rubber_da_glove" wrote:

Your so lovely Sarah :giveflower:

::bigwetsnog::

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"Newlywed630" wrote:

Sarah, your such a amazing person to take this and help others. Thank you so much.

Am I at risk? I have had 1 c/s and 1 d and c. At my 20 week scan with Trevor the u/s tech turned on color and looked things for a very long time. Would this be one of the things she was looking for?

Yeah, you are in a risk group because of the surgeries. Definitely make sure they properly examine your placenta at your 20 week scan to look for cord insertion, placement etc. Like i said above.

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"TyrantOfTheWeek" wrote:

:lurk:

Since when are you prego again!!! I quit stalking and look what happens...

Awesome news!!

YEAHIAM!!!!! :woohoo:

Thanks chick! Biggrin

Minx_Kristi's picture
Joined: 01/02/09
Posts: 1261

I just want to echo what everyone else has said, that you are SO amazing! I honestly do not know how you do it, you deserve an award.

My sister suffered a loss in 2001, baby was late and since meeting you I wonder now if VP had anything to do with it as there has never been an actual explanation as to why the baby died.

How exactly if it hasn't been detected due pregnancy would they know the cause once baby is born?

Keep up the fantabulous work you're dong lovely Smile

xx

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"Minx_Kristi" wrote:

I just want to echo what everyone else has said, that you are SO amazing! I honestly do not know how you do it, you deserve an award.

My sister suffered a loss in 2001, baby was late and since meeting you I wonder now if VP had anything to do with it as there has never been an actual explanation as to why the baby died.

How exactly if it hasn't been detected due pregnancy would they know the cause once baby is born?

Keep up the fantabulous work you're dong lovely Smile

xx

Hey, i know you! Biggrin

I'm really sorry about your sisters loss. Sad They only discovered that my loss was due to Vasa Praevia when they examined the placenta after delivery. They could see from that how the blood vessels were running through the membranes, instead of being inserted directly into the placenta.

Did your sister have a post mortem or anything? Or a debriefing meeting at the hospital?

Minx_Kristi's picture
Joined: 01/02/09
Posts: 1261

I think she was told something a long the lines of 'it's one of those things that just happens'.

I'm pretty sure she didn't pursue it further either, probably because of she had no reason to think it could've been caused by anything different iykwim?

Also, baby was still very active the morning she passed.... it's all very odd. I wish my sister had been a lot more assertive back then but grief can make people not think straight.

xx

Uropachild's picture
Joined: 08/09/05
Posts: 1176

Yeah, you got that right! Grief does strange things to a person. In some ways it gives you what you need to remain strong, but in others it helps you make wrong decisions aout things.

KatieWantsABaby's picture
Joined: 06/19/07
Posts: 229

Good News here! My big u.s was done by a radiologist and she triple checked to make sure there were no problems with the placenta or the vessels in it. We are entirely in the clear! This did worry me after getting pregnant immediately after my D&C and I am thrilled! If it hadn't been for this post I probably wouldn't have mentioned the D&C to her, or the uterine surgery last year.

Thank you so much for giving us all the info you knew about risk factors/etc.

Joined: 06/09/06
Posts: 3264

Sarah, hopefully you'll be happy to know that my OB automatically checks for vasa previa (and other placenta issues) at the 'big' ultrasound. I was really happy to hear that. Biggrin

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"KatieWantsABaby" wrote:

Good News here! My big u.s was done by a radiologist and she triple checked to make sure there were no problems with the placenta or the vessels in it. We are entirely in the clear! This did worry me after getting pregnant immediately after my D&C and I am thrilled! If it hadn't been for this post I probably wouldn't have mentioned the D&C to her, or the uterine surgery last year.

Thank you so much for giving us all the info you knew about risk factors/etc.

EXCELLENT news!! You must feel really reassured. It's wonderful when medical folks take this seriously and put you at ease. Good stuff! Biggrin

Uropachild's picture
Joined: 08/09/05
Posts: 1176

"gottharf" wrote:

Sarah, hopefully you'll be happy to know that my OB automatically checks for vasa previa (and other placenta issues) at the 'big' ultrasound. I was really happy to hear that. Biggrin

Definitely pleased to hear that. It's such a shame that he doctors here in the UK arn't as forward thinking as some of the ones over there.

KatieWantsABaby's picture
Joined: 06/19/07
Posts: 229

it was extremely reassuring to know all is okay (and that the Dr's involved with my OB clinic are so absolutely wonderful about putting my mind at ease Smile )

Newlywed630's picture
Joined: 07/20/07
Posts: 770

I was also checked for this at my last u/s! I was happy to hear that it looks great!