Differential diagnosis, investigations and treatment
We diagnosed vasa praevia. Emergency caesarean section was performed.
We predicted that the foetal vessels were running on the anterior wall
of the lower uterine segment. When the lower uterine segment was incised
transversely, we were very careful not to injure the foetal vessels
before delivery. Careful blunt entry using haemostats and fingertips was
performed. The amniotic membrane was exposed without rupture of the
membrane and injury to foetal vessels.
Foetal vessels were found in the
exposed amniotic membrane (Figure 2A). Because the vessels were running
on both sides of membrane, the amniotic membrane was ruptured at the
central part. A mature female baby was safely delivered. The neonate had
a birth weight of 2890 g (appropriate for gestational age) and Apgar
scores were 8 and 9 at 1 and 5 minutes, respectively. We examined the
intrauterine findings after delivery. As we diagnosed before the
operation, a section of the foetal vessels was meandering and running
over the internal cervical os (Figure 2B). Both the placental position
and the site of the umbilical cord insertion were above the low
transverse incision scar (Figure 2C).