Antenatal diagnosis and management of type III vasa previa

Authors

  • Kamakshi Mam Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India https://orcid.org/0009-0003-8136-5502
  • Diksha Garg Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
  • Sunayna Lashkari Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
  • Sahithi Kosgi Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
  • Avantika Gupta Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20261649

Keywords:

In vitro fertilization, Still birth, Fetal exsanguination, Colour doppler, Trans vaginal sonography, Vasa previa

Abstract

Vasa previa is rare but potentially life-threatening condition for fetus, in which unprotected fetal vessels traverse the membranes over or near the internal cervical os, placing the fetus at risk of rapid exsanguination if undiagnosed. The risk is increased in pregnancies conceived by in vitro fertilization (IVF). With prior written consent of the patient, we report a rare case of type III vasa previa in an IVF pregnancy, diagnosed antenatally and managed successfully. A 26-year-old primigravida with IVF conception was found to have placenta previa on mid-trimester scan. Serial ultrasonography with color Doppler from 28 weeks demonstrated persistent unprotected fetal vessels near the internal os. The pregnancy was managed with close antenatal surveillance, corticosteroid administration, and planned hospitalization. An elective cesarean section at 35 weeks resulted in the delivery of a healthy neonate. Placental examination confirmed Type III vasa previa. This case underscores the importance of targeted ultrasound screening and planned delivery in improving perinatal outcomes.

References

Society of Maternal-Fetal (SMFM) Publications Committee; Sinkey RG, Odibo AO, Dashe JS. #37: diagnosis and management of vasa previa. Am J Obstet Gynecol. 2015;213(5):615-9.

Ruiter L, Kok N, Limpens J, Derks JB, de Graaf IM, Mol BW, et al. Incidence of and risk indicators for vasa praevia: a systematic review. BJOG. 2016;123(8):1278-87.

Jauniaux E, Savvidou MD. Vasa praevia: more than 100 years in preventing unnecessary fetal deaths. BJOG. 2016;123(8):1287.

Bronsteen R, Whitten A, Balasubramanian M, Lee W, Lorenz R, Redman M, et al. Vasa previa: clinical presentations, outcomes, and implications for management. Obstet Gynecol. 2013;122(2 Pt 1):352-7.

Pavalagantharajah S, Villani LA, D’Souza R. Vasa previa and associated risk factors: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2020;2(3):100117.

Schachter M, Tovbin Y, Arieli S, Friedler S, Ron-El R, Sherman D. In vitro fertilization is a risk factor for vasa previa. Fertil Steril. 2002;78:642-3:03253.

Catanzarite V, Maida C, Thomas W, Mendoza A, Stanco L, Piacquadio KM. Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases. Ultrasound Obstet Gynecol. 2001;18(2):109-15.

Suekane T, Tachibana D, Pooh RK, Misugi T, Koyama M. Type-3 vasa previa: normal umbilical cord insertion cannot exclude vasa previa in cases with abnormal placental location. Ultrasound Obstet Gynecol. 2020;55(4):556-7.

Jauniaux E, Alfirevic Z, Bhide AG, Burton GJ, Collins SL, Silver R, et al. Vasa praevia: diagnosis and management: green-top guideline No. 27b. BJOG. 2019;126(1):e49-61.

Oyelese KO, Turner M, Lees C, Campbell S. Vasa previa: an avoidable obstetric tragedy. Obstet Gynecol Surv. 1999;54(2):138-45.

Kamijo K, Miyamoto T, Ando H, Tanaka Y, Kikuchi N, Shinagawa M, et al. Clinical characteristics of a novel “Type 3” vasa previa: case series at a single center. J Matern Fetal Neonatal Med. 2022;35(25):7730-6.

Takemoto Y, Matsuzaki S, Matsuzaki S, Kakuda M, Lee M, Hayashida H, et al. Current evidence on vasa previa without velamentous cord insertion or placental morphological anomalies (Type III vasa previa): systematic review and meta-analysis. Biomedicines. 2023;11(1):152.

Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107(4):927-41.

Kim JJ, Bonhomme K, Oppenheimer LW, Gaudet L. Type III vasa previa associated with resolution of a low-lying placenta: case report and literature review. AJP Rep. 2024;14(2):e136-9.

Pozzoni M, Sammaria C, Villanacci R, Borgese C, Ghisleri F, Farina A, et al. Prenatal diagnosis and postnatal outcome of Type-III vasa previa: systematic review of literature. Ultrasound Obstet Gynecol. 2024;63:24-33.

Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126(3):654-68.

Gagnon R. No. 231: guidelines for the management of vasa previa. J Obstet Gynaecol Can. 2017;39(10):e415-21.

Oyelese Y, Javinani A, Gudanowski B, Krispin E, Rebarber A, Akolekar R, et al. Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus. Am J Obstet Gynecol. 2024;231(6):638.e1-24.

Ranzini AC, Oyelese Y. How to screen for vasa previa. Ultrasound Obstet Gynecol. 2021;57(5):720-5.

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Published

2026-05-28

How to Cite

Mam, K., Garg, D., Lashkari, S., Kosgi, S., & Gupta, A. (2026). Antenatal diagnosis and management of type III vasa previa. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(6), 2278–2281. https://doi.org/10.18203/2320-1770.ijrcog20261649

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Section

Case Reports