I do disagree that all vasa previa have a VCI though. Sometimes an errant vessel from the margin of the placenta is is what is overlying the cervix, and the cord insertion can be totally normal. Sometimes the vasa previa is connected to a succenturiate lobe, and again, not connected to the cord insertion at all.
Erin Daughterty, can you explain the physiology behind your comment that many babies with a vasa previa have DIC?
I think that any good caregiver, regardless of whether they are an obstetrician or not, can often detect fetal distress and compromise.
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^
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Originally Posted by erindaugherty
Your story is a great arguement for OB care.Erin
This will happen no matter where the birth takes place and no matter who is managing the labor and delivery.
The baby is healthy because the mom did a good job of caring for her before the birth, not because of who the healthcare provider is.
Mom to two perfect kids surrogate to two sweetpotatos born 4.21.11
I love someone with ataxia telangiectasia http://www.atcp.org
Mom to two perfect kids surrogate to two sweetpotatos born 4.21.11
I love someone with ataxia telangiectasia http://www.atcp.org
Scary though, now I wish I had asked for the ultrasound guy to look at that. Darn it! Now I have one more thing to worry myself with.
I had a velamentous insertion of the cord with my first pregnancy, but not a vasa previa. I had sensed something was wrong with the cord, and actually had 5 ultrasounds including vaginal ones to look to see if anything was crossing the cervix (mostly because I also had a borderline low-lying placenta as well). The cord and insertion was looked at on ultrasound and no abnormality was detected. Even after birth, they were not sure it was a velamentous insertion until it was dissected by pathology. From what I have read, velamentous insertion can be picked up by ultrasound some of the time, but not always even with the highest level ultrasound. By the way, I had a 100% normal, healthy pregnancy and even did non-stress tests (I was overdue) which were all completely normal. Even if the velamentous insertion had been detected, no intervention would have been taken.
In my case, my water broke spontaneously at home. At this time, some of the vessels ruptured where the placenta inserted the membranes and my baby bled out. Fortunately we were near the hospital and had a great neonatology team and the baby survived. She does have moderately severe cerebral palsy (can't sit at 20mo), seizures, etc., but is cognitively pretty good. She had extremely profound and diffuse brain injury so nobody quite understands how she is doing so well.
Where I gave birth (largest maternity hospital in IL by volume of births), the high-risk OB who had been there 30 years had only seen this 5 times. Almost all of the babies die. My daughter is one of only a few survivors that we are aware of.
I am 26 weeks, first pregnancy, have already had a level II ultrasound. I am going to find out if they will have another chance to look at the cord where it meets the placenta. I will ask the doc at my next appointment.
I will also share this with others since it is so important to prevent.
Again, thanks and bless you.
expecting boy: 8/10-ish
I do agree that babies with proven vasa previa should be born by c-section, but worry that in this culture, if we routinely look at cord insertion as part of the ultrasound and there is even a question of a VCI or some other abnormality, we will have even MORE unnecessary c-sections. These are associated with life threatening (as well as many less severe) complications for both mothers and babies, including very significant risks for subsequent babies conceived after the cesarean. Ironically, these risks may include vasa previa itself! They certainly include placenta accreta (lifethreatening to mom), placenta previa, and intrauterine growth restriction for the baby. Just some food for thought. Vasa previa is a devastating complication, but thankfully quite rare. There is an important role for prenatal diagnosis, but information that is poorly understood (by docs, perinatologists, midwives, etc.) can be more dangerous than no information at all.
FYI, I think the DIC link is that any person (baby or adult) that loses a large amount of blood can be at risk of DIC. This can happen at the extreme end of postpartum hemorrhage also, but is thankfully incredibly rare because of all of the effective interventions we have to control hemorrhages when they happen.
I had severe bleeding at about 13 weeks, felt like my water had broken. I went to the emergency room and they said my cervix was dialating and I would miscarry. That never happend. The bleeding went on for about a month, and everytime they did an ultrasound or fetal heart check it was fine. At my 20 week ultrasound they found that my daughter had a two vessel cord. No biggie since they didnt see any other abnormalities.
Fast forward to the end of my pregnancy. I was overdue and was induced with pitocin and they broke my water. My baby girl came out, perfectly healthy, apgars of 8 and then 9. She was 7 lbs 2.5 oz.
When the placenta came out the midwife announced that it had a velamentous insertion. My daughters pediatrician came to the hospital right away, and they did a few ultrasounds of her organs and such. We went home from the hospital the next day, and she is a happy healthy 11 month old today. I was on edge my whole pregnancy, because of the bleeding and then the vessel problem... I am glad I didnt know about the insertion issue. My daughter and I are living proof that babies with this issue can be happy and healthy.
I had no abnormal bleeding, no signs of anything being out of the ordinary. Just a straightforward labor.
It was an induced labor, using pitocin AND artificial rupture of membranes. After receiving an epidural, my labor and delivery went fairly quick. After a few hours and a few pushes, I delivered a baby girl!
However, my midwife realized after the birth that the baby had a velamentous inserted cord. It was not detected in uteruo through ultrasound.
Ironically, my first child, born 2 years previous, had a very short umbilical cord, that also was not detected until after the birth. His delivery was very hard and long and ended with forcepts. I personally think his cord was stretched to the max to get him out and the doctor didn't realize.
Apparently, my body has a problem manufactoring an umbilical cord! These cord issues are supposed to be rare... and I had a weird one, twice.
I'm at the point where I'd love to add another child to the family but I'm really scared about the cord issues. Any advice?
Vasa previa is scary, but not all VCIs result in vasa previa, by a long shot. The one thing I have taken away from all this is to NOT allow AROM in future pregnancies. I had SROM at home in a low-intervention birth and that's definitely a good thing!
My M/W had commented that had I had AROM he might have bled out. ( my membranes broke, btw when it head was almost completely out...)
I am so thankful that I have a hands off m/w because I was scheduled to deliver at an OB who waned to force induction on me at 40 weeks ( my son came on his own at 40 weeks 5 days...)
I had had a total placenta previa with him, DX at the 18 week U/s and was gone by 24 weeks...but was still low lying.
My ds is fine now,vibrant healthy, getting intomy cabinets as we speak *LOL*...my m/w said she knew why he had to come quick, and he did! one hour and 58 minutes from first contraction to birth.
Oh and I will add that I had massive bleeding right around the time of conception, or rather implantation, so much so that I had no idea I was even pg until I was almost 4 months along...
I have never bled like that with any of my other kids, ever, and I had that feeling the entire pg (once i found out) that something was wrong...too.
Does anyone know WHY this happens in some pg's? And if you have it one pg can it happen another time too?
just curious. Thanks for bumping this thread
I just wanted to explain to those who asked that anytime a person loses a huge amount of blood they are at risk for DIC. You lose clotting factors and the clotting cascade goes awry. It isn't just neonates, its moms or people who lose lots of blood in a trauma.
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