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Vasa previa

Key sources
The following summarized guidelines for the evaluation and management of vasa previa are prepared by our editorial team based on guidelines from the Society of Obstetricians and Gynaecologists of Canada (SOGC 2023; 2017), the Royal College of Obstetricians and Gynaecologists (RCOG 2019), and the Society for Maternal-Fetal Medicine (SMFM 2015).
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Guidelines

1.Screening and diagnosis

Indications for screening: as per SOGC 2023 guidelines, obtain targeted screening for vasa previa in all pregnant individuals with a risk factor.
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  • Diagnosis

2.Diagnostic investigations

Ultrasound: as per SOGC 2023 guidelines, assess the placental cord insertion site in all pregnant individuals at the routine second-trimester fetal anatomical scan.
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3.Diagnostic procedures

Pathological examination: perform placental pathological examination to confirm the diagnosis of vasa previa, in particular when stillbirth has occurred or where there has been acute fetal compromise during delivery.
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4.Medical management

Antenatal hospitalization
As per SOGC 2023 guidelines:
Consider offering hospitalization at 32 weeks of gestation in patients with vasa previa and before 32 weeks in patients with additional risk factors for early delivery (such as multiple gestation or a short cervix).
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Consider ensuring timely access to an operating room, an obstetrician, an anesthetist, and an appropriate NICU when deciding the location of admission for observation or delivery.
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  • Antenatal corticosteroids

5.Surgical interventions

Cesarean delivery, planned, SOGC: offer Cesarean delivery at 35+0 to 35+6 weeks in patients with vasa previa and singleton pregnancy. Consider offering earlier delivery in the presence of additional risk factors for preterm delivery.
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  • Cesarean delivery (emergency)

  • Cesarean delivery (setting of care)