Vasa Praevia
Admission & discharge
Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.
When admission or continued hospital care is needed
- Ruptured membranes, bleeding or labour with suspected/known vasa praevia requires immediate obstetric attendance and preparation for urgent caesarean/neonatal care.
When clinic, day care or home care may be suitable
- If diagnosed antenatally without symptoms, hospitalisation versus outpatient monitoring requires an individual specialist plan; do not apply a universal admission week to every patient.
Before going home
- After antenatal assessment, a clear birth/emergency plan and reliable rapid access are in place.
- After birth, use mode-of-birth recovery criteria and ensure any neonatal haemorrhage/resuscitation follow-up is handed over separately.
Discharge medicines and treatment changes
- Document indicated antenatal treatment; avoid an unsourced routine home tocolytic course. After birth use the actual operation/postnatal prescription.
Tests, pending results and their reviewer
- Confirm the diagnosis and relevant imaging/birth plan with the specialist team.
Home care and counselling
- Explain exactly which symptoms require emergency attendance and which hospital can provide urgent caesarean and neonatal care.
Follow-up: when and what to review
| When | Action / responsible service |
|---|---|
Before leaving antenatal care | Give the next specialist review and planned birth date/place. |
After birth | Follow maternal surgical/postnatal and neonatal specialist plans. |
Return urgently
- Bleeding, ruptured membranes, contractions or reduced fetal movements need immediate maternity contact.
Open the complete discharge checklist →
Treatment
① Immediate stabilization — first minutes
- Unsuspected intrapartum event: declare fetal emergency → category-1 caesarean within minutes
- Neonatal team primed for anaemia/resuscitation (cord gases, possible transfusion)
③ First-line treatment & drug regimens
- ANTENATAL DIAGNOSIS: corticosteroids 28+0–33+6 window (course completion before planned birth)
- PLANNED CAESAREAN 35+0–36+0 weeks (asymptomatic uncomplicated Type I/II per SMFM/RCOG-era practice; individualise earlier with bleeding/growth issues)
- Admit ~30–34 wks if bleeding episodes/risk factors accumulate
- ROM at home with confirmed vasa praevia: come in immediately even without contractions
Definitive treatment
Timed caesarean BEFORE membrane rupture. Vaginal birth is contraindicated.
Monitoring
- Growth scans q3–4 wks (coexisting FGR risk)
- CTG on any bleeding/ROM presentation
- Colour-flow confirmation scan at 32 & 35 wks (persistent)
Escalation
- Category-1 caesarean pathway
- Neonatal ICU alert for anticipated anaemia (Hb check at birth; isotonic volume expander/O-negative blood ready)
⑮ Complications & their management
Fetal exsanguination
Immediate birth + neonatal resuscitation with volume; umbilical cord blood gas; O-negative emergency blood for neonate
Missed diagnosis
Audit + document; risk-factor-based screening policy improvement
Post-treatment care
- Standard caesarean recovery
- Next pregnancy: early TVS Doppler screening at 16–20 wks + 28 wks
Diagnosis & assessment
- Fetal bradycardia after ROM
- Any APH with known vasa praevia
- Triangular vessel pattern seen at speculum
Definition: Type I: velamentous cord insertion vessels crossing os. Type II: vessels between placental lobes (bilobed/succenturiate lobe).
Risk factors
Presentation
- Usually ANTENATALLY SILENT unless screened
- Classic intrapartum: rupture of membranes → sudden fetal bradycardia → dark bleeding (often minimal visible!)
Initial assessment
- Suspect with risk factors → TVS greyscale + colour Doppler across os at booking/anomaly/28-wk scans
- Confirmed case: document clearly, counsel, plan birth
- Intrapartum suspicion: IMMEDIATE caesarean — do not wait for blood confirmation (Apt/alkali denaturation tests are historic adjuncts only)
Investigations
| Test | Looking for |
|---|---|
TVS colour Doppler | Vessels overlying internal os (diagnostic) |
CTG | Variable decelerations→bradycardia sequence |
Sources (8)
2022-02 · checked 2026-08-23 · pending-verification
Open source ↗
Cited via RCOG GTG73 update note; direct PDF audit pending — flag
· checked 2026-10-18 · verified-live
Open source ↗
Primary information read: individualised admission by bleeding/history/access, urgent attendance for bleeding/pain/contractions, specialist PAS/vasa praevia birth planning and postoperative/fertility counselling. No universal asymptomatic admission week is inferred.
31 March 2021 · updated 10 June 2025 · checked 2026-10-18 · verified-live
Open source ↗
Scope: additional clinical-detail explanation for lscs, vbac-tolac. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Additional admission/discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.
· checked 2026-10-18 · verified-live
Open source ↗
Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.
· checked 2026-10-18 · verified-live
Open source ↗
Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.
· checked 2026-10-18 · verified-live
Open source ↗
Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…
· checked 2026-10-18 · verified-live
Open source ↗
Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.