• Chapter 33 : Midwifery and obstetric

emergencies.
• Vasa praevia
• -The term vasa praevia is used when a fetal blood
vessel lies over the os, in front of the presenting
part.
• - This occurs when fetal vessels from a
velamentous insertion of the cord or to a
succenturiate lobe cross the area of the internal
os to the placenta.

• -
• The fetus is in jeopardy, owing to the risk
of rupture of the vessels, which could lead
to exsanguination.
• - Good outcome depends on antenatal
diagnosis and delivery by caesarean
section before the membranes rupture
• -Vasa praevia may be diagnosed
antenatally using ultrasound. Sometimes,
vasa praevia will be palpated on vaginal
examination when the membranes are still
intact.
• - If it is suspected a speculum examination
should be made.
• Ruptured vasa praevia
• -When the membranes rupture in a case
of vasa praevia, a fetal vessel may also
rupture.
• - This leads to exsanguination of the fetus
unless birth occurs within minutes.
Diagnosis
• Fresh vaginal bleeding, particularly if it
commences at the same time as rupture of
the membranes, may be due to ruptured
vasa praevia.
• -Fetal distress disproportionate to blood
loss may be suggestive of vasa praevia.
Management
• The midwife should call for urgent medical
assistance. The fetal heart rate should be
monitored. If the mother is in the first stage
of labour and the fetus is still alive, an
emergency caesarean section is carried
out.
• -If in the second stage of labour, delivery
should be expedited and a vaginal birth
may be achieved.
• - Caesarean section may be carried out
but mode of birth will be dependent on
parity and fetal condition.
• -There is a high fetal mortality associated
with this emergency and a paediatrician
should therefore be present for the birth.
• -If the baby is born alive, resuscitation,
haemoglobin estimation and a blood
transfusion will be necessary.
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