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Vasa Previa: A Cautious Approach at Caesarean Section Amanda Gomes, MD; Juliana Rezende, MD; Maria de Fátima Vogt, MD, PhD; Alberto Zaconeta, MD, PhD Department of Obstetrics and Gynecology, University Hospital of Brasilia, Brasilia, Brazil
E
lective CS is the cornerstone of the treatment for women with antenatal diagnosis of vasa previa,1 but the optimal surgical technique has not been well-established. Because the main goal of the surgery is to prevent laceration of aberrant vessels and fetal hemorrhage,2 a useful tip is to start a transverse hysterotomy superficially so that, as the incision is gradually deepened into myometrium, the intact membranes bulge out from it, enabling visualization of the vessels running toward the cervix (Figure).3 Then, the fetus is delivered by controlled amniotomy away from the vessels. Although other researchers have suggested that preoperative mapping of the lower abdomen with 3-D power Doppler is mandatory,4,5 the utility and reproducibility
of this mapping remain undetermined. The technique reported here, without preoperative mapping, has been used with success3,6 and, in our practice, demonstrated to be safe and easy to perform. Consent to publish these images was obtained from patients.
J Obstet Gynaecol Can 2017;39(4):203e204 https://doi.org/10.1016/j.jogc.2017.01.021 Copyright ª 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
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REFERENCES
1. Bronsteen R, Whitten A, Balasubramanian M, et al. Vasa previa: clinical presentations, outcomes, and implications for management. Obstet Gynecol 2013;122:352e7. 2. Smorgick N, Tovbin Y, Ushakov F, et al. Is neonatal risk from vasa previa preventable? The 20-year experience from a single medical center. J Clin Ultrasound 2010;38:118e22.
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3. Neuhausser WM, Baxi LV. A close call: does the location of incision at cesarean delivery matter in patients with vasa previa? A case report. F1000Res 2013;2:267. 4. Matsubara S, Kuwata T, Takahashi H, et al. Vasa previa: another ultrasound sign and caution at cesarean section. J Matern Fetal Neonatal Med 2016;29:1139e40. Epub 2015 Apr 29. 5. Canterino JC, Mondestin-Sorrentino M, Muench MV, et al. Vasa previa: prenatal diagnosis and evaluation with 3-dimensional sonography and power angiography. J Ultrasound Med 2005;24:721e4. 6. Breborowicz GH, Markwitz W, Szpera-Gzdziewicz A, et al. Prenatal diagnosis of vasa previa. J Matern Fetal Neonatal Med 2015;28:1806e8.