Our final late bleeding sign that we're
going to talk about today is a vasa previa.
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.
They're attached to the amniotic sac
and the amniotic sac is very, very thin.
So there are types of vasa previa,
the first one is a velamentous insertion.
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.
When we have a succenturiate lobe, we have a
placenta that sort of divided into two halves.
So instead of being one large
piece of placenta, we have
pieces of placenta that are
together, it's divided up.
And then finally we have a battledore
and battledore just means the edge.
So instead of the placenta
being attached to the center
and the vessels being attached to the
center of the placenta, it's marginal.
Now all of these things weaken
the structure of the umbilical cord.
What's in the umbilical cord?
The arteries and veins that actually
feed the fetus oxygen and food.
So we want that to be super secure,
in the case of vasa previa, it is not.
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.
So with the ultrasound, we'll be able to see how
those vessels are connected into the placenta.
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.
We can also note bleeding, especially
after rupture of the membranes.
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.
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.
And that begins to make sense if you
think about what's going on anatomically.
Let's talk about management for a vasa previa.
So, if we have a succenturiate lobe
or if we have a battledore insertion,
then we may not notice that prior to delivery.
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.
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.
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.
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.
If the bleeding is particularly
heavy, then we want to make sure
that we're ready to manage the shock.
So this is IV fluids and medications, so that's
going to be another piece of managing this bleeding.