Vasa Praevia: Diagnosis and Management (Green-top Guideline 27b)


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the Royal College of Obstetricians, Gynaecologists

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Executive summary

Management of women with undiagnosed vasa praevia at delivery

Emergency caesarean delivery and neonatal resuscitation, including the use of blood transfusion if required, are essential in the management of ruptured vasa praevia diagnosed during labour.

Grade of recommendation: B

Placental pathological examination should be performed to confirm the diagnosis of vasa praevia, in particular when stillbirth has occurred or where there has been acute fetal compromise during delivery. [ New 2018 ]

Grade of recommendation: ✓

Can vasa praevia be diagnosed antenatally?

The performance of ultrasound in diagnosing vasa praevia at the time of the routine fetal anomaly scan has a high diagnostic accuracy with a low false-positive rate. [ New 2018 ]

Grade of recommendation: B

A combination of both transabdominal and transvaginal colour Doppler imaging (CDI) ultrasonography provides the best diagnostic accuracy for vasa praevia.

Grade of recommendation: D

Should we screen for vasa praevia?

There is insufficient evidence to support universal screening for vasa praevia at the time of the routine midpregnancy fetal anomaly scan in the general population.

Grade of recommendation: D

Although targeted midpregnancy ultrasound screening of pregnancies at higher risk of vasa praevia may reduce perinatal loss, the balance of benefit versus harm remains undetermined and further research in this area is required. [ New 2018 ]

Grade of recommendation: ✓

How should women with vasa praevia be managed?

Because of the speed at which fetal exsanguination can occur and the high perinatal mortality rate associated with ruptured vasa praevia, delivery should not be delayed while trying to confirm the diagnosis, particularly if there is evidence that fetal wellbeing is compromised. [ New 2018 ]

Grade of recommendation: ✓

In the presence of confirmed vasa praevia in the third trimester, elective caesarean section should ideally be carried out prior to the onset of labour.

Grade of recommendation: ✓

A decision for prophylactic hospitalisation from 30–32 weeks of gestation in women with confirmed vasa praevia should be individualised and based on a combination of factors, including multiple pregnancy, antenatal bleeding and threatened premature labour. [ New 2018 ]

Grade of recommendation: ✓

In cases of vasa praevia that develop premature rupture of membranes and/or labour at viable gestational ages, a caesarean section should be performed without delay.

Grade of recommendation: D

To avoid unnecessary anxiety, admissions, prematurity and caesarean section, it is essential to confirm persistence of vasa praevia by ultrasound in the third trimester.

Grade of recommendation: ✓

At what gestation should elective delivery occur?

The ultimate management goal of confirmed vasa praevia should be to deliver before rupture of membranes while minimising the impact of iatrogenic prematurity. Based on available data, planned caesarean delivery for a prenatal diagnosis of vasa praevia at 34–36 weeks of gestation is reasonable in asymptomatic women. [ New 2018 ]

Grade of recommendation: D

Administration of corticosteroids for fetal lung maturity should be recommended from 32 weeks of gestation due to the increased risk of preterm delivery.

Grade of recommendation: ✓

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