Ruptured vasa previa in velamentous cord insertion placenta

Ruptured vasa previa is rare but usually catastrophic if delivery is not imminent. We present a case of ruptured vasa previa in velamentous cord insertion placenta. The fetus survived despite 6 h of a venous rupture because of the tamponade effect from fetal head engagement. Defects in the vessel wall architecture were revealed by histopathologic examination and might be responsible for the vessel rupture. Prenatal sonographic identification of cord insertion site into the placenta is encouraged as standard of practice to prevent this accident.