Prenatal Diagnosis and Management of Vasa Previa

Vasa previa is a rare but potentially life-threatening obstetric condition in which unprotected fetal vessels traverse the membranes across or near the cervical os. Early recognition in the second trimester is key to preventing catastrophic fetal haemorrhage at membrane rupture. Routine assessment of placental cord insertion and systematic Doppler evaluation during the anatomy scan have emerged as central components of screening protocols. Transvaginal ultrasound with colour Doppler provides high sensitivity for detecting aberrant vessels, particularly in the presence of a low-lying placenta or velamentous cord insertion. Once diagnosed, management hinges on balancing the risks of prematurity against the danger of spontaneous rupture. Protocols often recommend inpatient monitoring or outpatient surveillance depending on individual risk factors, administration of antenatal corticosteroids to mature fetal lungs and planned caesarean delivery between 34 and 37 weeks’ gestation. Multidisciplinary care involving obstetricians, sonographers and neonatologists underpins successful outcomes. Recent advances emphasise standardised definitions, consensus on optimal delivery timing and the growing role of patient-reported outcomes to refine both clinical pathways and caregiver support.

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Prenatal Diagnosis and Management of Vasa Previa publication trend

The graph below shows the total number of articles in prenatal diagnosis and management of vasa previa across all publications each year (not limited to Nature Index journals).

Technical terms

Vasa previa: A condition where fetal blood vessels cross or run near the internal cervical os without placental protection.

Velamentous cord insertion: An abnormal insertion of the umbilical cord into the fetal membranes, leaving vessels unsupported by Wharton’s jelly.

Low-lying placenta: Placental tissue located near but not covering the cervical os, often prompting further imaging to exclude vasa previa.

Transvaginal ultrasound: An ultrasound examination performed via the vagina to obtain high-resolution images of the cervix and lower uterine segment.

Doppler ultrasound: An imaging technique that uses Doppler effect principles to visualise and assess blood flow within vessels.

References

1. Vasa previa in singleton pregnancies: diagnosis and clinical management based on an international expert consensus. American Journal of Obstetrics and Gynecology (2024).
2. Incidence of vasa praevia: a systematic review and meta-analysis. BMJ Open (2023).
3. The impact of ultrasound-based antenatal screening strategies to detect vasa praevia in the United Kingdom: An exploratory study using decision analytic modelling methods. PLOS ONE (2022).
4. Women- and clinician- important outcomes and priorities regarding vasa praevia: An international qualitative study to inform development of a core outcome set. Women and Birth (2024).