Vasa Previa

 

 

NOTE: Vasa Previa is not directly related to Asherman's Syndrome but is linked to a history of curettage and therefore may occur in women with past Asherman's Syndrome.

First of all, it is right that possible complications of Asherman's Syndrome are placenta accreta and placenta previa. But I didn´t know that it is quite possible to have also a vasa previa with a placenta previa (not obligatory!! but possible!). The definition of vasa previa is: 

A rare (1:3000), heartbreaking condition which occurs when one or more of the baby’s placental or umbilical blood vessels cross the entrance to the birth canal beneath the baby. When the cervix dilates or the membranes rupture, the unprotected vessels can tear, causing rapid fetal hemorrhage. When the baby drops in to the pelvis, the vessels can be compressed, compromising the baby’s blood supply and causing oxygen deprivation.

 

Prognosis

When properly diagnosed antepartum, prognosis of survival is very good. The foetal mortality rate is very low when an elective C-section is performed after foetal lung maturity is adequate.

Antepartum Diagnosis

Changing current routine obstetrical ultrasound protocols to include checking the placental cord connection for velamentous cord insertion during all routine obstetrical ultrasounds is recommended (preferably with colour Doppler). All suspected cases of velamentous cord insertion, placenta praevia, low-lying placenta, multi-gestational pregnancies, and multi-lobed placentas need to be checked for vasa praevia with advanced ultrasound techniques, specifically level 2 ultrasound of the lower uterine segments and/or transvaginal colour Doppler ultrasound. Vasa praevia can be detected during pregnancy as early as the 16th week with use of transvaginal sonography in combination with colour Doppler. Infant death from vasa praevia is preventable if diagnosed antenatally.

Warning Signs

Vasa praevia might be present if any (or none) of the following conditions exist: low-lying placenta (may be caused by previous miscarriages followed by curetting of the uterus (D&C), or uterine operations, which causes scarring in the uterus), bilobed or succenturiate-lobed placentas, pregnancies resulting from in-vitro fertilization or multiple pregnancies. Vasa praevia bleeding is painless. Other OB or birthing bleeding complications are not necessarily painless.

Treatment

When diagnosed antepartum, treatment plans could include the following: use of tocolytes to stop all uterine activity; bed rest; no sexual intercourse, vaginal exams, lifting, heavy straining during bowel movements (use of stool softeners); hospitalization; foetal monitoring; regular ultrasounds to monitor progression of vasa praevia; determination of source of bleeding (either foetal or maternal); amniocentesis to access foetal lung maturity; steroid treatment to develop foetal lung maturity; and most importantly, elective caesarean delivery early enough to avoid an emergency but late enough to avoid complications of prematurity. When not diagnosed antepartum, aggressive resuscitation complete with blood transfusion for the infant if necessary must be planned for and/or expected.

Personal Experience Comments

With all the information from the vasa group I went back to the hospital and insisted to stay there until delivery! Thanks again to Erika Martel (many hugs!!!) and also Corinna who convinced me to stay in hospital, because I really didn´t believe in the incredible danger of life for the baby but also for me! Now I know about the danger of a pregnancy after AS, and espcially if there is still any scarring. For that I am of the same opinion as Corinna and many others in the group that you should not get pregnant with scarring. And of course, monitoring you and the baby very closely and also insisting to look for vasa previa (special US). As Susan Kunin is writing: it is hard to stay in bed all the time but believe me it would be much more cruel to risk baby´s and your life!!

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