Vasa Previa – Late Pregnancy Bleeding (Nursing)

00:01 Our final late bleeding sign that we're going to talk about today is a vasa previa.

00:07 So a vasa previa is a condition in which the fetal vessels, so when we think about the umbilical cord and the placenta, those vessels are actually not quite attached to the whole placenta.

00:19 They're attached to the amniotic sac and the amniotic sac is very, very thin.

00:25 So there are types of vasa previa, the first one is a velamentous insertion.

00:30 So you could see on this graphic, we have the branches of the umbilical cord, they're not in the placenta, they're sitting above the placenta.

00:39 When we have a succenturiate lobe, we have a placenta that sort of divided into two halves.

00:45 So instead of being one large piece of placenta, we have pieces of placenta that are together, it's divided up.

00:52 And then finally we have a battledore and battledore just means the edge.

00:55 So instead of the placenta being attached to the center and the vessels being attached to the center of the placenta, it's marginal.

01:02 Now all of these things weaken the structure of the umbilical cord.

01:07 What's in the umbilical cord? The arteries and veins that actually feed the fetus oxygen and food.

01:13 So we want that to be super secure, in the case of vasa previa, it is not.

01:21 So how are we going to assess for a vesa previa because all of that is inside? Again, our ultrasound is going to be our key.

01:28 So with the ultrasound, we'll be able to see how those vessels are connected into the placenta.

01:33 Are they on the side? Are they in the amniotic sac? Or do we have a succenturiate lobe? What can we see? All of those can be detected on ultrasound.

01:43 We can also note bleeding, especially after rupture of the membranes.

01:47 So think about it, if our umbilical cord and all those vessels are attached in the amniotic sac instead of in the placenta and the water breaks, it'll rip right through those arteries and veins.

01:59 So what will the client tell you when they present? Well, my water broke, and then I just noticed this really big gush of heavy bleeding right afterwards.

02:07 And that begins to make sense if you think about what's going on anatomically.

02:12 Let's talk about management for a vasa previa.

02:15 So, if we have a succenturiate lobe or if we have a battledore insertion, then we may not notice that prior to delivery.

02:24 So the client may deliver, they're holding their baby, the placenta comes out and then we say, 'Oh, wow! We have a situation where we have a succenturiate lobe or we have a battledore insertion and that's interesting to note.

02:36 If however, we have a velamentous insertion, where the vessels are attached to the amniotic sac rather than to the placenta itself, then this is going to be a highly dangerous situation.

02:47 And if we don't recognize that prior to birth, then we have a really good chance that the baby will not survive because as soon as that water breaks, those vessels are cut and then the baby has no way to get oxygen.

03:00 So if we know before, we're going to prepare for a cesarean birth from the very beginning so that we won't have a rupture of the membranes.

03:08 If the bleeding is particularly heavy, then we want to make sure that we're ready to manage the shock.

03:13 So this is IV fluids and medications, so that's going to be another piece of managing this bleeding.