Mismanaged Vasa Previa Can Cause Birth Injuries Such As Hypoxic Ischemic Encephalopathy (HIE) & Cerebral Palsy
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Unborn babies depend on a steady source of oxygen-rich blood from their mother; this is the fetus’s only source of oxygen. Umbilical cord prolapse, nuchal cord (cord wrapped around baby’s neck), placental abruption, uterine rupture and problems with vessels in the uteroplacental circulation can cause the baby to experience a severe lack of oxygen in her brain, called birth asphyxia. Vasa previa is a very serious blood vessel problem that can cause birth asphyxia, hypoxic ischemic encephalopathy (HIE), brain damage, and lifelong conditions such as cerebral palsy, seizure disorders, intellectual disabilities and developmental delays.
What is Vasa Previa?
Vasa previa is a condition in which the baby’s blood vessels are exposed and covering the opening to the birth canal (the external os). In normal uteroplacental circulation, the baby’s blood vessels travel within the umbilical cord and insert into the central region of the placenta. In vasa previa, some of the baby’s blood vessels travel within the fetal membranes and across the opening of the birth canal. The vessels insert into the surface of the placenta and are “exposed” because they are not protected by the umbilical cord or placental tissue.
Blood vessels affected by vasa previa are at risk of rupturing when the fetal membranes rupture or during labor and delivery. A rupture can cause the baby to lose a lot of blood – even 50% or more of the baby’s total blood volume. If the baby survives this blood loss, she may experience the following devastating conditions:
- Hypoxic ischemic encephalopathy (HIE). HIE usually involves damage to the basal ganglia, cerebral cortex or watershed regions of the brain, but it sometimes includes periventricular leukomalacia (PVL).
- Neonatal encephalopathy
- Permanent brain damage
- Seizure disorders
- Cerebral palsy (CP)
- Intellectual disabilities
- Developmental delays
- Motor disorders
- Periventricular leukomalacia
How is Vasa Previa Diagnosed and Managed?
When vasa previa is present, the baby’s health depends on a timely diagnosis. Due to the risk of sudden and severe bleeding if the vessels rupture, a C-section delivery should be scheduled.
During prenatal visits, physicians use ultrasound technology to check for significant problems with the major vessels involved in uteroplacental circulation, including those in the umbilical cord. As early as the 16th week of pregnancy, vasa previa can be detected by a transvaginal ultrasound coupled with use of color Doppler.
Vasa previa that is present during the second trimester may resolve over time. Usually, though, vasa previa persists and the vessels are at risk of rupturing.
Once vasa previa is diagnosed, the mother should have nonstress tests performed twice a week, beginning at 28 to 30 weeks of gestation, to look for any evidence of umbilical cord compression. Due to the increased risk of preterm delivery, a steroid called betamethasone should be given between 28 and 32 weeks of gestation to help the baby’s lungs and other tissues mature. In addition, the mother should be admitted to the hospital between weeks 30 and 32 for more frequent fetal heart rate monitoring. At this point, nonstress tests should be performed 2 to 3 times a day. A scheduled C-section should take place at about 35 weeks of gestation.
An emergency C-section delivery should be performed if any of the following occur
- Premature rupture of the membranes (PROM)
- Nonreassuring fetal heart tracings, especially repetitive variable decelerations not helped by medications given to suppress labor (tocolytics)
- Vaginal bleeding accompanied by nonreassuring fetal heart tracings such as a fast heart rate (tachycardia) or a sinusoidal heart rate pattern, or evidence of pure fetal blood
Sadly vasa previa often goes undiagnosed. Vasa previa should be suspected when vaginal bleeding occurs at the time of membrane rupture. Vaginal bleeding during rupture should alert the medical team to make preparations for an emergency C-section delivery. If the baby’s heart rate is non-reassuring, a C-section delivery must occur within a matter of minutes to prevent major blood loss in the baby, birth asphyxia and permanent brain damage. A non-reassuring heart rate means the baby is experiencing a lack of oxygen to her brain. The type of non-reassuring heart tracings typically seen on the fetal monitor when vasa previa is causing severe bleeding are sinusoidal patterns and slow heart rates that can get extremely low.
When vessels rupture, it is critical that members of the medical team quickly order blood products for the baby so that once the baby is delivered by emergency C-section she can be given a blood transfusion. Transfusions are often life-saving when a baby is affected by vessel rupture caused by vasa previa.
What Are the Risk Factors for Vasa Previa?
Risk factors for vasa previa include the following:
- Pregnancies resulting from in-vitro fertilization (IVF)
- Multiple gestation
- Low-lying placenta or placenta previa (even if it corrects itself)
- Velamentous cord insertion. (The cord inserts into the fetal membranes instead of the placenta, and the vessels of the umbilical cord are not protected by Wharton’s jelly, making them more likely to rupture.)
- Bilobed placenta (The placenta is abnormally shaped, having 2 equal-sized lobes connected by a thin bridge.)
- Succenturiate-lobed placenta. (The placenta has an additional lobule separate from the main part of the placenta.)
- Maternal history of D&C or uterine surgery
Vasa previa can be diagnosed with simple tests. Given the potential for severe blood loss and brain damage in a baby, physicians should check for this condition during prenatal testing, and the medical team should be hyperalert to the potential for vasa previa if the mother has any of the risk factors listed above. Failure to timely diagnose vasa previa is negligence. It also is negligent behavior to fail to quickly deliver a baby by emergency C-section if the baby has a nonreassuring heart tracing – especially if vaginal bleeding occurs at the time of membrane rupture. If a medical team’s negligence leads to permanent injury in the baby such as brain damage, hypoxic ischemic encephalopathy or cerebral palsy, it is medical malpractice.
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Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children with birth injuries for almost 3 decades. If your child was diagnosed with a birth injury such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award-winning lawyers at ABC Law Centers can help. We have helped children throughout the U.S. obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success.
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Video: Vasa Previa Lawyers Discuss Birth Asphyxia and Its Causes
Watch a video of vasa previa lawyers Jesse Reiter & Rebecca Walsh discussing the numerous causes of birth asphyxia.
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