What happens if you experience bleeding during pregnancy but don’t experience any pain? Be alert, it could be a sign of vasa previa. Vasa previa is a condition in which the fetus’s blood vessels are not protected by the placenta.
The following is a complete explanation of the causes, symptoms shown, and how to overcome or treat vasa previa.
What is Vasa Previa?
Citing the siteHealthline, Vasa previa is a pregnancy complication in which some of the blood vessels connecting the umbilical cord to the placenta cross or are very close to the internal opening of the cervix.
Meanwhile, the site WebMD He explained that if the membranes surrounding the baby rupture, these blood vessels can also rupture. This can cause the baby to lose a lot of blood and complications for the mother.
This condition is extremely rare. The largest study reported that vasa previa occurs in only up to 4 out of 10,000 pregnancies. And when it does occur, it can be very severe.
These blood vessels are located within the membranes, unprotected by the umbilical cord or placenta, and are therefore at risk of rupture when the waters break – either at the onset of spontaneous or premature labor.
As many as 56% of vasa previa cases go undiagnosed and result in stillbirth. However, if the condition is detected early during pregnancy, the chance of fetal survival can increase to 97%.
Women who are most at risk of developing vasa previa are those associated with the following conditions:
- Experiencing placenta previa, which is when the placenta covers part or all of the cervix.
- Pregnancy occurs through in vitro fertilization (in vitro fertilization/IVF )
- Pregnancy with multiple babies
- Active smoker
- Chronic health conditions such as diabetes
Causes and Risk Factors
The cause of vasa previa is currently unknown. However, it is thought to have two main causes:
1. Velamentous Cord Insertion (Velamentous Cord Insertion)
During pregnancy, the baby receives nourishment from the placenta through the umbilical cord. The umbilical cord is normally attached to the center of the placenta, and its blood vessels are protected within this structure.
In umbilical cord insertion, the umbilical cord is inserted into the amniotic sac, not into the placenta. As blood vessels flow through the amniotic sac, the umbilical cord lacks the membrane protection and is coveredWharton Jelly– the inner part of the umbilical cord that contains a jelly-like substance. If the blood vessels in the amniotic sac are above the cervix, this condition can cause vasa previa.
2. Bilobed Placenta (Bi-lobed Placenta), Multilobed, or Succenturiate
The placenta in the uterus can form two lobes (called a bilobed placenta)—rarely, it can form more than two lobes (called a multilobed placenta), and sometimes it can even form smaller lobes (called a succenturiate lobe). In this case, vasa previa occurs when the blood vessels that run between the lobes eventually attach to the cervix.
A bilobed, multilobed, or succenturiate placenta can occur if the placenta implants in one of the following locations:
- Above the fibroid in the uterus
- Area of decreased blood supply
- Previous areas of operation
- Above the cervix
When your baby is ready to be born, the amniotic sac ruptures. The baby then moves through the cervix and out through the vagina. If you have vasa previa, the rupture of the amniotic sac also causes blood vessels to rupture. This can cause your baby and possibly you to lose a lot of blood.
Diagnosis of Vasa Previa
The best method for detecting vasa previa is to perform a transvaginal scan performed internally and combined with color Doppler.
The way it works is by inserting a transducer (a device that can convert one form of energy into another) in the form of a thin, straight probe into the vagina a few inches by the sonographer – the rest of the wand or transducer remains outside the body.
The transducer produces ultrasound waves, and this tool is much more accurate than using an abdominal scan, because it allows the sonographer to see the desired area clearly.
The color on the Doppler allows the technician to see which direction the blood is flowing and at what speed.
However, the above tests are usually performed after a doctor has already received a diagnosis based on an ultrasound. Because this health condition is relatively rare, this examination method is not routinely performed.
And your doctor may recommend this test if you have one or more of the risk factors and symptoms described above.
Symptoms of Vasa Previa
Signs or symptoms of vasa previa are usually not felt by pregnant women , and often go undetected until delivery – in more than half of cases where it is not detected in pregnancy, it results in stillbirth.
Symptoms associated with vasa previa also typically don’t become apparent until labor begins. Signs typically appear when the fetus is experiencing significant distress or after a stillbirth.
Signs or symptoms experienced and not recognized by pregnant women with vasa previa are:
- Painless vaginal bleeding, a sign of ruptured membranes.
- Blood from bleeding is dark in color – because the baby’s blood does not have as much oxygen as your blood so the blood appears darker.
- The baby’s heartbeat in the womb is slow.
If you experience this, seek medical help immediately. If a diagnosis is made, it’s usually during a routine obstetric ultrasound mid-pregnancy.
A mid-pregnancy ultrasound is a standard antenatal examination to assess the location of the placenta and umbilical cord. At this time, doctors may detect vasa previa and then perform additional tests and recommend follow-up.
If the condition does not resolve during pregnancy, early delivery by cesarean section is usually recommended. This is to prevent the onset of labor or premature rupture of membranes, which can be associated with rapid and significant fetal blood loss.
How to Prevent and Overcome
Besides the inability to detect symptoms and signs, there’s no way to prevent vasa previa. However, if a doctor can diagnose it based on an ultrasound before delivery, the baby’s chances of survival are very good with proper care.
In some cases, vasa previa can also disappear during pregnancy. Therefore, if your obstetrician has diagnosed you with vasa previa, it’s important to ensure you’re under professional care.
Together with your doctor, you can effectively manage your pregnancy, allowing it to develop safely and optimally, and helping you cope with potential risks—premature labor or water breaking.
The goal of treatment is to safely prolong the mother’s pregnancy and prevent rupture of blood vessels when early delivery is recommended. Other treatments include:
- Monitor the baby with non-stress tests twice a week starting between weeks 28 and 32.
- Mothers may be hospitalized between 30 and 32 weeks for closer monitoring of the baby. In some cases, pregnant women with vasa previa require hospitalization during the third trimester for close monitoring and complete bed rest.
- Corticosteroid injections to help the baby’s lungs mature.
- Pelvic rest may be recommended, which means avoiding sex or inserting anything into the vagina.
- A planned C-section delivery between 34 and 37 weeks of gestation is recommended. This is to prevent natural contractions that could cause the membranes to rupture spontaneously, which could then result in ruptured blood vessels in the baby and bleeding in the mother.
When vasa previa is not diagnosed during the prenatal period, spontaneous labor or rupture of membranes can cause serious health problems due to severe fetal bleeding, including:
- Fetal or neonatal death
- Severe fetal anemia requiring transfusion
- Cerebral palsy
So far, vasa previa does not pose any physical health risks to the mother during childbirth. However, the risks are greater for the baby, as it can result in death or birth defects (cerebral palsy).
If you are diagnosed with this condition, seek immediate medical care to ensure the baby’s safe and optimal survival. We wish you continued health throughout your pregnancy.
Republished with permission from theAsianParent Indonesia
