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      Rotura de vasa previa: a propósito de un caso

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          Abstract

          Vasa previa es una condición rara vez reportada, en la cual, vasos sanguíneos aberrantes procedentes de la placenta o del cordón umbilical, cruzan la entrada del canal del parto por delante de la presentación. Ocurre en 1:3000 nacimientos, con una elevada mortalidad perinatal. Se presenta el caso de una multípara de 38 años de edad, quien ingresó con diagnóstico de hemorragia genital del III trimestre. Se programó cesárea de urgencia obteniendo neonato vivo femenino a término y Apgar de 8 puntos al 1º minuto. Como hallazgo de la intervención destaca placenta fúndica normoinserta con rotura de vasa previa. Madre y neonato fueron alojados conjuntamente en maternidad con una evolución intrahospitalaria satisfactoria. Se concluye que el diagnóstico y la conducta oportuna, darán lugar a resultados satisfactorios, logrando disminuir notablemente la mortalidad por esta rara pero igualmente letal entidad clínica.

          Translated abstract

          Vasa previa is a rarely condition in which, aberrant blood vessels coming from the placenta or the umbilical cord, cross the entrance of the childbirth channel before presentation. It happens in 1:3000 births, with a high perinatal mortality. A case of a 38 years-old multigravida is reported who entered to the hospital with diagnostic of third trimester genital bleeding. Cesarean section was performed obtaining a term female alive newborn with 8 points from Apgar scale at the first minute. As discovery of the intervention it highlights normal-insert and fundical placenta with vasa previa rupture. Mother and newborn were housed jointly in maternity room with a successful evolution. It concludes that a diagnosis and an opportune behavior, they will give place to satisfactory results, being able to diminish the mortality notably for this strange but equally lethal clinical entity.

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          Most cited references19

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          Vasa previa: an avoidable obstetric tragedy.

          Vasa previa is a rarely reported condition in which the fetal blood vessels, unsupported by either the umbilical cord or placental tissue, traverse the fetal membranes of the lower segment of the uterus below the presenting part. The condition has a high fetal mortality due to fetal exsanguination resulting from fetal vessels tearing when the membranes rupture. Despite improvements in medical technology, vasa previa often remains unsuspected until this fatal fetal vessel rupture occurs. Significant reduction in the fetal mortality from this condition depends on a high index of suspicion leading to antenatal diagnosis, and elective delivery by cesarean. We believe transvaginal ultrasound in combination with color Doppler is the most effective tool in the antenatal diagnosis of vasa previa and should be utilized in patients at risk, specifically those with bilobed, succenturiate-lobed, and low-lying placentas, pregnancies resulting from in vitro fertilization, and multiple pregnancy. Where there has been antepartum or intrapartum hemorrhage, especially when associated with fetal heart irregularities, we also recommend a test to exclude fetal blood in the vaginal blood. Similarly, amnioscopy before amniotomy may help to diagnose this condition. Cesarean delivery is the method of delivery of choice, and aggressive resuscitation of the affected neonate may be life saving. With a high index of suspicion, antenatal diagnosis using transvaginal sonography in combination with color Doppler, elective delivery by cesarean, and aggressive resuscitation of the neonate where fetal vessel rupture has occurred, the mortality from this complication may be considerably reduced. Obstetricians & Gynecologists, Family Physicians. After completion of this article, the reader will be able to identify the risk factors and associated conditions for vasa previa, to identify the various clinical presentations and management of vasa previa, and to be aware of the diagnostic tools available to make the antepartum diagnosis of vasa previa.
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            Poor perinatal outcome associated with vasa previa: is it preventable? A report of three cases and review of the literature.

            We describe three cases of vasa previa and review the English-language literature for all cases reported since 1980. Antenatal diagnosis was significantly associated with decreased fetal mortality (p = 0.033). A low-lying placenta is a risk factor for vasa previa, as it occurred in 81% of patients.
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              Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome.

              To describe the prenatal ultrasonographic diagnosis, natural evolution, and clinical outcomes of vasa previa in a large population at a single institution.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                og
                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                0048-7732
                March 2005
                : 65
                : 1
                : 19-22
                Affiliations
                [1 ] Hospital Central Universitario  Dr. Antonio María Pineda
                Article
                S0048-77322005000100004
                5469fbb7-463c-4f7d-a23a-adc7c95bdb9e

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en
                Categories
                OBSTETRICS & GYNECOLOGY

                Obstetrics & Gynecology
                Vasa previa rupture,Placenta   Umbilical,Pregnancy Vaginal,genital bleeding,Cesarean section,Rotura de vasa previa,Placenta   cordón umbilical,Embarazo  Sangramiento genital,Cesárea

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