A Fatal Complication During Pregnancy!

Image Source: The New England Journal of Medicine©

A 37-year-old pregnant woman at 27 weeks of gestation presented to the obstetrical clinic for her routine prenatal visit. She had no active complaints. Transvaginal ultrasonography (TVS) showed a low-lying posterior placenta (normally the placenta is anterior and away from the os) and velamentous cord insertion.

Velamentous cord insertion is a complication where the umbilical cord inserts onto the chorioamniotic membrane (fetal surface) rather than the placenta. Normally, 99% of the time, the umbilical cord inserts onto the mid of the placenta; in 1% of the pregnancies, the umbilical vessels, on their way to the placenta, diverge while traversing the chorioamniotic membranes.

The mother underwent transvaginal color Doppler ultrasonography, which showed that the internal os of the cervix is covered by the traversing fetal blood, a finding consistent with vasa previa.

An elective cesarean section with a low, transverse incision was performed at 34 weeks of gestation, which revealed fetal blood vessels crossing over the intact amniotic membrane that covered the head of the fetus (Panel B).

Examination of the placenta revealed membranous vessels that merged to form the umbilical cord, confirming the presence of velamentous cord insertion (Panel C).

The intrapartum course was uncomplicated; however, the neonate had transient tachypnea of the newborn but recovered completely afterward. There were no other complications, so both mother and baby were discharged soon after.

In vasa previa, the fetal vessels are around 2 cm from the internal os of the cervix or over the os, unprotected by the Wharton’s jelly, thus prone to compression and rupture during vaginal delivery and labor.

The most common presentation is painless vaginal bleeding at the time of labor when the membrane rupture or after amniotomy. The blood loss is primarily from the fetal vessels; therefore, it is fatal for the baby. Bleeding due to vasa previa causes abnormal fetal heart tracing and increased risk of fetal mortality.

If diagnosed earlier, it is best to plan elective cesarean section between 34 to 36 weeks of gestation to avoid complications as vasa previa is associated with adverse perinatal outcomes.


Shinya Matsuzaki, M. P. (2019, January 17). Vasa Previa. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1808778

Rocha J, Carvalho J, Costa F, Meireles I, do Carmo O. Velamentous cord insertion in a singleton pregnancy: an obscure cause of emergency cesarean-a case report. Case Rep Obstet Gynecol. 2012;2012:308206. doi:10.1155/2012/308206

Previous articlePlasma Therapy, Safe for COVID-19?
Next articleTwo Travellers with Tick Fever
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


Please enter your comment!
Please enter your name here