Twin pregnancy complicated by vasa previa

Area of Science:

• Maternal-fetal medicine
• Diagnostic imaging in obstetrics

Background:

• Vasa previa poses significant risks for perinatal morbidity and mortality if not diagnosed antenatally.
• Twin pregnancies are associated with an increased risk of vasa previa.

Observation:

• A case of vasa previa in a twin pregnancy was diagnosed postnatally despite serial antenatal ultrasounds failing to identify a bilobed placenta, velamentous cord insertion, or vasa previa.
• Vaginal bleeding occurred during the expulsive stage of labor at 37 weeks, necessitating assisted delivery.
• The first twin was born pale and anemic, requiring blood transfusion and therapeutic hypothermia.

Findings:

• Postnatal diagnosis of vasa previa in a twin pregnancy resulted in severe fetal anemia and complications.
• Risk factors for vasa previa include low-lying placentas, bilobed placentas, velamentous umbilical cord insertions, multiple gestations, and assisted reproductive technologies.

Implications:

• Antenatal diagnosis of vasa previa is critical for preventing severe fetal complications.
• Transvaginal ultrasound with color flow Doppler is recommended for screening high-risk pregnancies to enable early vasa previa detection.
• Improved antenatal diagnosis protocols can significantly enhance perinatal outcomes in cases of vasa previa.