Vasa praevia – ultrasonographic diagnosis and clinical management

A.I. Ilie, C. Gică, B.A. Cimpoca, R. Botezatu, G. Peltecu, A.M. Panaitescu, N. Gică

Rezumat: Introduction. Vasa praevia is a high-risk, uncommon disorder of placentation. The possible fetal complications of ruptured vasa praevia include asphyxia, hemorrhage, rapid exsanguination and fetal or neonatal death. Materials and method. We searched PubMed, MEDLINE and the Cochrane Library using appropriate variables (e.g., “vasa praevia”, “placenta praevia”, “velamentous cord insertion”, “succenturiate”, “bilobed placenta”) and medical literature pertaining to vasa praevia up to January 2021. We selected randomized control trials, observational studies, systematic reviews and four national guidelines. The diagnostic and management strategies recommended in medical literature were compared and reviewed. Results. A risk-adapted approach has been widely used to facilitate the ultrasonographic diagnosis of vasa praevia. The use of transvaginal color and pulse wave Doppler has not proven cost-effective in the general population, however it is recommended in the evaluation of patients in high-risk groups. Not all cases of vasa praevia can be diagnosed antenatally. Conclusions. Vasa praevia is a rare obstetrical condition that has been associated with a high perinatal mortality rate if undiagnosed antenatally. Standardized prenatal targeted screening protocols for vasa praevia in both singleton and multifetal pregnancies are needed in order to improve the diagnosis of vasa praevia, the neonatal survival and to lower the rate of intra- and postpartum complications.
Cuvinte cheie: vasa praevia, placental anomalies, velamentous umbilical cord insertion, bilobed placenta, ultrasound diagnosis, vasa praevia management.