Vasa previa is associated with velamentous cord insertion and requires consideration of delivery timing. If diagnosed prenatally, what is the recommended delivery approach?

Vasa previa is associated with velamentous cord insertion and requires consideration of delivery timing. If diagnosed prenatally, what is the recommended delivery approach?

• A. Cesarean delivery at 34 to 35 weeks
• B. Vaginal delivery at term if possible
• C. Immediate delivery at 28 weeks regardless
• D. No special delivery consideration beyond routine care

Answer: (A)

Vasa previa with velamentous cord insertion poses a high risk of fetal hemorrhage if a labor starts or the membranes rupture, because the unprotected fetal vessels run over the cervix or are exposed in the membranes. Because of this danger, the safest plan when diagnosed before labor is to have a planned cesarean delivery before labor begins. The typical timing is around 34 to 35 weeks gestation to balance the risk of prematurity with the risk of vessel rupture during labor. If time allows, antenatal steroids may be given to help fetal lung maturity. Vaginal delivery or proceeding to term without scheduling a cesarean would expose the fetus to the catastrophic risk of intrapartum vessel rupture. Delivering much earlier isn’t routinely necessary unless there are other concerns.

Vasa previa with velamentous cord insertion poses a high risk of fetal hemorrhage if a labor starts or the membranes rupture, because the unprotected fetal vessels run over the cervix or are exposed in the membranes. Because of this danger, the safest plan when diagnosed before labor is to have a planned cesarean delivery before labor begins. The typical timing is around 34 to 35 weeks gestation to balance the risk of prematurity with the risk of vessel rupture during labor. If time allows, antenatal steroids may be given to help fetal lung maturity. Vaginal delivery or proceeding to term without scheduling a cesarean would expose the fetus to the catastrophic risk of intrapartum vessel rupture. Delivering much earlier isn’t routinely necessary unless there are other concerns.