Hi! I had velamentous cord insertion during my 4th pregnancy, in 1996. Unfortunately, I also had vasa previa. Mine ruptured at term and the baby died a couple of days after birth due to the injuries he sustained. Not much was known about vci or vasa previa back then. I found only 6 medical journal articles on the condition, had to go to 2 different medical school libraries to retrieve them all, and they were all success cases only because they were prenatally diagnosed by accident while following up some other condition. Since then I have helped found the International Vasa Previa Foundation
. I've seen many hundreds of these cases in the last 4 years, participated in organizing a major research project on it, and can eliminate some of the confusion here.
Velamentous cord insertion by itself is not all that uncommon. It happens once or twice in every 100 pregnancies. Usually without any problems (about 70% of the time). But it can be very dangerous to the infant and can be prenatally diagnosed. If the vessels cross the cervix (vasa previa) they will with almost absolute certainty rupture at or near term or delivery, with or without the doctor's help (by breaking the waters). Mine broke spontaneously at home as I was going into labor, which is very common for cases of undiagnosed vasa previa. I never had a contraction. Even if the vessel(s) do not cross the cervix (vasa previa), they can still break and sometimes do, but this is pretty rare. They can also be compressed by the baby, effectively accomplishing the same thing. Here at the International Vasa Previa Foundation (IVPF) we are working to ensure that a scan of the placental end of the cord connection becomes becomes routine practice during all obstetrical ultrasounds. The cord connection can be visualized more than 99% of the time, even with only black and white ultrasound (though color Doppler is preferred) and it only takes 20 - 60 seconds to do so.
I have to disagree that not breaking the water in cases of vasa previa will avoid a rupture. This is simply not true. If vessels are crossing the cervix, the baby cannot be born vaginally (in almost every case) without these vessels rupturing. As this is fetal blood, a rupture will immediately compromise the infant. It was highly unusual that I made to the hospital while my baby was still alive. His heart stopped after arrival and they were able to rescussitate him after an emergency C-section, but it really was too late. Too much damage had been done. The infant mortality rate for undiagnosed vasa previa is 50-90%. I sure wish doctors would check first before breaking the water. Most of the cases of vp that I've heard of that were diagnosed in labor were made by astute midwives rather than OBs.
There are 2 known types of vasa previa: velamentous cord insertion and bi-lobed, succenturiate lobed placenta. Its important to note that most cases of vci or succenturate lobed placenta are not vasa previa though. But if you do have vessels crossing the cervix, you have a disaster waiting to happen. Its like a time bomb waiting to go off at birth. VP happens about once in every 2500 pregnancies.
Since Nathan died there has been a lot more medical papers published on these conditions (about 100 that I know of). IVPF recommendations are based on current research that could only have been accomplished with the help of our organization. The condition is rare enough that doctors seldom if ever see a case. Most notably the recommendations are to check the placental cord connection during routine obstetrical ultrasounds, and follow up with transvaginal color Doppler ultrasound (the test of choice) for any pregnancies with risk factors for vasa previa. Risk factors include vci; bi-lobed/succenturiate lobed placenta; low-lying placenta (even if it corrects itself!); maternal history of uterine surgery or D&C; multiple gestation (twins, triplets, etc); and assisted conception (i.e. in-vitro fertilization). If vasa previa is found, the IVPF recommends pelvic rest (including no vaginal exams other than the transvaginal ultrasound), hospitalization in the 3rd trimester, and C-section delivery by 35 weeks. They also recommend immediate blood transfusions for the infant if a rupture does occur. A vp rupture is painless for the mother, unlike other forms of bleeding in pregnancy. My son lost more than half his blood in only a moment.
LOL! I think I've probably over done it. As you can tell, I am passionate about this subject. Babies don't need to die from vasa previa, though in the past almost all of them did. Prenatally diagnosed cases that are properly managed have a near 100% infant survival rate. I've never seen a prenatally diagnosed baby die because of vasa previa. Information is soooo important. Unfortunately, many women have to be their own advocate when it comes to a vp diagnosis. The information hasn't caught up with all the doctors yet. The good news is that more and more vp babies are being prenatally diagnosed all the time and its become very easy to research this condition on the internet. So sorry for the long post! Thanks for listening. I hope this helps.
Mum to Nathan Elliot Paris ^i^http://NathanParis.com
International Vasa Previa Foundationhttp://www.vasaprevia.org
Risk Factors, Testing, and IVPF Management Recommendations for Vasa Previa:http://www.vasaprevia.org/education/recommendations.htm
Sign up to receive the free IVPF newsletter:http://groups.yahoo.com/group/IVPF
To join the Vasa_Previa email discussion group, visit:http://groups.yahoo.com/group/Vasa_Previa
Medical Resources on Vasa Previahttp://www.vasaprevia.org/resources/resources.htm
IVPF Slide Show about vasa previa
online - http://www.vasaprevia.org/Docs/IVPFslideshow.htm
Frequently asked questions about vasa previa:http://www.vasaprevia.org/faqs/faqs.htm
Help us research vasa previa by filling in the IVPF research questionnaire:http://www.vasaprevia.org/education/questions.htm
Save babies from an untimely death due to vasa previa by JOINING the International Vasa Previa Foundation, Inc. as a participating member!
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