QuestionSBA
QuestionChoice
Whilst uterine rupture is a cause of foetal distress, this usually presents with sudden onset and continuous abdominal pain. There is often a history of previous caesarean section.
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d
Uterine rupture
QuestionChoice
Whilst umbilical cord prolapse is a cause of foetal distress, this occurs after the membranes have ruptured. This woman reports no history of vaginal loss on admission.
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e
Umbilical cord prolapse
QuestionChoice
Whilst placental abruption is a cause of foetal distress, this condition usually presents with sudden and severe abdominal pain, accompanied by a "woody" hard uterus and foetal distress.
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c
Placental abruption
QuestionChoice
Placenta praevia occurs where part of the placenta overlies the cervical os. This can lead to brisk antepartum haemorrhage before or during labour. This is less likely in this case as there was no visible antepartum haemorrhage, and the description of the placenta fits a type 1 vasa praevia.
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Placenta praevia
QuestionChoice
Vasa praevia occurs when the vessels in the umbilical cord run within the foetal membranes. These vessels may rupture spontaneously in early labour. Vasa praevia can be divided into types; in type 1 vasa praevia, the umbilical cord is inserted into the membranes rather than directly into the placenta (also known as a velamentous insertion) and in type 2 vasa praevia, the umbilical vessels run from the placenta to a succenturiate placental lobe.
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Vasa praevia
QuestionComment
how can it be vasa praevia if there was no bleeding?

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vasa praevia is when the foetal blood vessels cross the cervical os. This will lead to APH when they burst but they don't always, Bursting of the blood vessels usually occurs with rupture of the membranes.
 If the delivery was attempted vaginally, there 100% would have been bleeding. But the baby was born by caesarian which probably did not give the blood vessels the chance to rupture
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# Summary


Vasa praevia is a potentially fatal obstetric condition where foetal vessels run near or across the internal cervical os, placing them at risk of rupture during membrane rupture. The classic triad of symptoms includes painless vaginal bleeding, rupture of membranes, and foetal bradycardia or death. Diagnosis is typically made antenatally via transabdominal or transvaginal ultrasonography. Management involves an elective caesarean section before the rupture of membranes, usually around 35-36 weeks of gestation. Emergency caesarean section is required if the mother goes into labour or her membranes rupture.


# Definition


Vasa praevia is a condition seen in obstetrics where the foetal vessels, unprotected by the umbilical cord or placental tissue, run dangerously close to or across the internal cervical os. These vessels are prone to rupture during the rupture of membranes, which can result in foetal haemorrhage and potentially foetal death.


# Aetiology


The aetiology of vasa praevia remains unclear, but it has been associated with multiple gestations, in vitro fertilization, and velamentous cord insertion.


# Signs and Symptoms


The classic triad of symptoms in vasa praevia includes:

- Painless vaginal bleeding
- Rupture of membranes
- Foetal bradycardia (or resulting foetal death)


# Differential Diagnosis


The differential diagnosis for vasa praevia includes placenta praevia and abruptio placentae. 

- Placenta praevia: Characterized by painless vaginal bleeding, but without the accompanying foetal bradycardia or death seen in vasa praevia. 
- Abruptio placentae: Typically presents with painful vaginal bleeding, abdominal pain, and uterine tenderness and rigidity. Foetal distress is common.

# Investigations

Diagnosis of vasa praevia is usually made with transabdominal or transvaginal ultrasonography. Most cases can now be diagnosed antenatally, a significant improvement from prior times when the condition was usually only diagnosed post-delivery following a foetal death due to haemorrhage.

# Management

The primary management strategy for vasa praevia is an elective caesarean section prior to the rupture of membranes, typically arranged for 35-36 weeks gestation. However, if the mother goes into labour or her membranes rupture, an emergency caesarean section should be carried out immediately to prevent foetal death.

# References


[Click here for the Green Top Guidelines on vasa praevia](https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg27b/)
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Vasa praevia
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Obstetrics
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A 25-year-old parous woman attends her local maternity unit in established labour at 39+7 weeks. She had a spontaneous vaginal delivery 2 years prior and has had no problems during either pregnancy. She is experiencing regular, painful contractions. She has not experienced any vaginal loss.

A cardiotocograph is performed upon admission, which reveals a foetal heart rate of 110 beats per minute, with deep decelerations with contractions that are slow to recover.

The woman is transferred to theatre for an emergency caesarean section, and a live male infant is delivered.

As the midwife examines the placenta to check the membranes are complete, she describes the umbilical cord as "velamentous".

What is the most likely cause of the intrapartum foetal distress?
a