VASA PREVIA

Question 1

Considerations for the Critical Vasa Previa

Answer 1

Maternal Resuscitation takes precedence

Treat hypotension in normal fashion

Place patient in LATERAL TILT POSITION or manually displace the uterus to the left

Initiate a massive transfusion protocol if hemodynamic stability is not achieved with 2-4 units of packed red blood cells (PRBC)

Assess Fetal Heart Rate

Immediately notify Obstetrics or Neonatology / Pediatrics

Definitive Treatment is C-Section

Call the neonatal ICU if available, and have type O-negative uncrossmatched blood in anticipation of resuscitation of a likely preterm newborn in hypovolemic or hemorrhagic shock.

Question 2

DDx

Answer 2

Placental Abruption
Placentia Previa
Vasa Previa
Prelabour Rupture of Membranes
Preeclampsia/Eclampsia

Normal Labour with Bloody Show
GU Trauma

Question 3

Clinical Features

Answer 3

Classic Triad:

Membrane Rupture

Painless vaginal bleeding

Fetal Bradycardia and Demise

Question 4

Investigations

Answer 4

Type and Cross

CBC

Coags

Fibrinogen Level

Transabdominal ultrasound with Doppler: may show sonolucent structure overlying internal os that has a Doppler consistent with fetal heart rate

Fetal Cardiotocometric Monitoring: may show fetal tachycardia, bradycardia, sinusoidal wave

Question 5

Treatment

Answer 5

Consult Obstetrics and Pediatrics

Definitive Treatment is C-Section

Anti-D immune globulin (RhoGAM) 300 μg intramuscularly for Rh- patient

Call the neonatal ICU if available

Type O-negative uncrossmatched blood in anticipation of resuscitation of a likely preterm newborn in hypovolemic or hemorrhagic shock.

Question 6

Disposition

Answer 6

Admission to Labour and Delivery Unit