My husband and I found out about vasa previa on the Internet. We
had never heard of it before. Vasa previa is rare condition, one
in every 2,500. If it goes undetected, it has a high fetal mortality
of 50% to 90% because of the hemorrhage that occurs when the vessels
are torn when the membranes rupture, either at labour or delivery.
When this happens, such as in Matthew's case, the baby looses blood
and oxygen. There are two types of vasa previa: multi-lobed placenta
and velamentous insertion of the umbilical cord. Velamentous cord
insertion is fairly common in pregnancies (1-2:100 pregnancies),
which can lead to vasa previa. Sometimes there is confusion thinking
that vasa previa and velamentous insertion of the umbilical cord
are one and the same. Although velmentous cord insertion is much
more common than vasa previa and women should take extra caution
and concern, it is not the same as vasa previa. Most cases of velamentous
cord insertion are successful whereas vasa previa are not unless
it has been prenatally diagnosed and managed adequately. I also
found that many people, including nurses, thought that vasa previa
was placenta previa. The terms might sound similar but they are
not the same. When a woman bleeds because of placenta previa, the
blood is maternal. When a woman bleeds because of vasa previa, the
blood is not maternal, it is all fetal blood loss.
Some of the risk factors include a low-lying placenta, placenta
previa, multiple pregnancies, in-vitro fertilization pregnancies,
a history of uterine surgery, painless bleeding or a D&C. A
D&C is considered a risk factor as this procedure has the potential
to cause uterine scarring. Anything that can cause uterine scarring
can potentially cause a low-lying placenta which is the main risk
factor for vasa previa as velamentous cord insertion and multi-lobed
placentas are thought to develop as a low-lying placenta moves up.
Also, from what I have read, the risk factors for vasa previa increases
with every pregnancy due to the wear and tear on the uterus. The
more damage done on the uterus, the harder it is for the placenta
to implant on areas of the uterus that have a better blood supply.
The reduction in the fetal mortality from this condition depends
on prenatal diagnosis; this is the key to a babys survival.
When vasa previa is found before labor, the baby has a 100% chance
of surviving. Vasa previa can be detected during pregnancy as early
as the 16th week. It can be seen with the help of a trained technician
and the use of transvaginal sonography. However, strongly suggest
to your doctor to send you to a location, such as a hospital, where
they can combine the use of a color Doppler as this increases the
chances of detecting it immensely. Unfortunately for me and for
other mothers who have lost their babies to this condition, some
doctors do not even bother looking at the cord insertion and therefore
do not perform these simple but invaluable tests.
Suggested management for women with vasa previa includes
hospitalization in the third trimester and delivery by c-section
at 35 weeks. I believe doctors do not want to pass the 35 week period
because then there is a greater chance of the membranes rupturing
on their own. Babies might be born prematurely but it is still safer
than waiting and a possible rupture.
Vasa = vessel
Previa = crossing the cervix
Normally blood vessels feeding the baby will travel from
the placenta through the umbilical cord and into the baby's
bellybutton. Vasa previa can develop when velamentous insertion
of the cord exists. The umbilical cord inserts at a distance
from the placenta, and its blood vessels travel relatively
unprotected in the fetal membranes, crossing the cervix,
to reach the placenta. Hence, the fetus has exposed blood
vessels that run right across the opening of the cervix.
Such as in Matthew's case, a baby will hemorrage and loose
oxygen to the brain, sometimes in a matter of minutes. The
doctor who performed the emergency c-section said that when
he initially had examined me he saw about 100 cc of blood
loss (which was Matthew's blood). Below you can see a link
from an Internet site that demonstrates how disasterous
vasa previa can be. However, the information is only provided
Many parents, like myself, who have loss a child to
vp, have undiagnosed vp miracles or were diagnosed during pregnancy
with vp are part of a group called the International Vasa Previa
Foundation (www.ivpf.org). Its headquarters
are in the USA but members are from around the world. We are trying
to set standards of care on trying to detect vasa previa during
pregnancy, specifically around the gestation period during the Level
I and Level II ultrasound scans. Efforts have been especially strong
in the UK, USA and Canada. Another goal is to have a set standard
of care for vasa previa throughout the obstetric community. With
the help of the IVPF, more and more Obstetricians are recognizing
the severity of this condition. However others, such as my former
OB/GYN, still have a lot to learn. The American College of Obstetricians
and Gynecologists has information published on vasa previa and I'm
hoping that through my letters and support, the Society of Obstetricians
and Gynaecologists of Canada will also recognize this anomaly and
hopefully set a standard of care. Also, with the continuous efforts
of the IVPF some ultrasound organizations now have guidelines to
include scanning the placental cord connection during routine obstetrical
ultrasound. It should be recommended guidelines for all women with
risk factors. As a result, more women are being prenatally diagnosed
these days, especially in the United States.
To conclude, I want to do what I can to remember
Matthew in a positive way. One way I have found is by joining the
support group for mothers like me with the International Vasa Previa
Foundation. It has been helping me as we all give each other support.
I understand that many people who have not experienced the loss
of a child do not understand the true depth of the pain it causes.
That is why the IVPF has helped me to talk to other bereaved parents
who understand. I have also attended several meetings with PBSO,
an organization for bereavered parents in Ontario. I urge others
who have experienced a loss to find a support group as it does make
a difference (see section under Links).
Another positive way to remember Matthew is by informing
people and creating awareness of this devastating condition. I know
many people are aware of this anomaly now through my efforts with
dedicating this website and creating the YouTube video clip. I also
held a walk in his memory (Sophie's Walk) in October 2006. As well,
I have sent many letters to the doctors and the SOGC trying to work
with them, although it has not been an easy task to say the least.
I do not feel that the onus should be on pregnant women but I encourage
women to be their own advocates. So please, pass this information
on to others. I am not doing this to shock or frighten moms-to-be
but instead I want them to be informed and aware. Ask your doctor
if he/she knows about vasa previa. If you have had one of the risk
factors mentioned above, ask to have extra testing. In fact, you
should not only ask but demand it! It is your body and your baby's
life! One last advice I can tell you is that if you're not happy
with your doctor, leave! Get a second or even third opinion. It
might be time consuming and inconvenient but in the end it might
make all the difference in the world.
I promised Matthew that I would do whatever I can
to raise awareness about this 'silent killer' so that other families
will not go through the tragedy that our family has gone through.
Fatal outcomes due to vasa previa can be prevented.
we must realize that each of us makes a difference with our life.
Each of us impacts the world around us every single day. We have
a choice to use the gift of our life to make the world a better
place - or not to bother."