Presentation of the umbilical cord vessels

Vasa praevia (presentation of the umbilical cord vessels) is a condition, in which the vessels run through the amniotic membranes in the area of the internal opening of the cervix uteri in front of the presenting part of the fetus. This is a rather rare pregnancy complication; its frequency is 1:1200-1:500 pregnancies. Pregnancy with vasa praevia can be complicated by compression of the vessels of the fetal presenting part or their rupture with subsequent blood loss, severe and fatal fetal conditions (fetal distress), and high perinatal morbidity and mortality. The neonatal survival rate substantially increases with timely antenatal diagnosis of vasa praevia. The paper comparatively analyzes modern international clinical protocols (Royal College of Obstetrics and Gynecologists (RCOG), College of Obstetrics and Gynecologists (COG), Society for Maternal-Fetal Medicine (SMFM), Royal Australian and New Zealand College of Obstetrics and Gynecologists (RANZCOG), and Society of Obstetricians and Gynecologists of Canada (SOGC) ones) and Russian guidelines for the antenatal diagnosis of vasa praevia, for the need for screening tests during pregnancy, the risk factors for this condition, the tactics of pregnancy management, the need for antenatal hospitalization, for delivery timing and methods in diagnosed and undiagnosed vasa praevia. When providing medical assistance to patients with vasa praevia, obstetricians/gynecologists are guided by the data of the international clinical protocols and those of the National Obstetrics Guidelines, since at the moment the Russian Federation has no unified clinical protocol for providing assistance in vasa praevia; however, there are instructions on delivery tactics in Order 572n. Conclusion. A national clinical protocol will be able to reduce fetal and neonatal morbidity and mortality rates. The timely antenatal diagnosis of vasa praevia is necessary for the choice of optimal management tactics in a pregnant woman, for compulsory hospitalization during the critical stages of pregnancy, for the determination of the gestational age of planned delivery, for the selection of an properly equipped hospital with practical experience in obstetric and neonatal care and with a neonatal intensive care and resuscitation units.

vasa praevia, vasa praevia, presentation of umbilical cord vessels