Fetoscopic Laser Ablation of Type II Vasa Previa-Case Report and Systematic Review

Vasa previa is a rare but potentially fatal obstetric condition in which fetal vessels traverse the internal cervical os without the protection of placental tissue or Wharton's jelly, making them highly vulnerable to rupture during labor or spontaneous membrane rupture. This can result in rapid fetal exsanguination and death. While current management involves planned cesarean delivery before the onset of labor, fetoscopic laser ablation (FLA) has recently emerged as a minimally invasive alternative for selected cases, particularly type II and III vasa previa, allowing for pregnancy prolongation and potential vaginal delivery. We report the case of a 40-year-old gravida 3 para 0 woman diagnosed with type II vasa previa at 22 + 5 weeks. FLA was performed successfully at 31 + 5 weeks without complications. At 36 + 5 weeks, she experienced spontaneous rupture of membranes and delivered a healthy male neonate via cesarean section at maternal request. To contextualize this case, we conducted a systematic review of 54 cases from the literature. FLA was associated with a 98.1% technical success rate, 50% vaginal delivery rate, and 100% neonatal survival, with no major maternal complications reported. These findings suggest that FLA may offer a safe and effective alternative to preterm cesarean delivery in selected patients.