26 – Vasa Praevia




26 Vasa Praevia



Shimma Rehman



Scenario in a Nutshell



Undiagnosed vasa praevia presenting with antepartum haemorrhage and fetal bradycardia in labour.


Stage 1: PV blood loss and fetal bradycardia at the time of membrane rupture.


Stage 2: Sustained fetal bradycardia, coordinate transfer to theatre.


Stage 3: Category 1 caesarean section under general anaesthesia, vasa praevia diagnosed and neonatal resuscitation required.



Target Learner Groups


All members of the multidisciplinary obstetric team: anaesthetists, midwives, obstetricians, operating department practitioners/anaesthetic nurses and neonatal emergency response teams.















Specific learning opportunities
Knowledge of causes of APH
Recognition of vasa praevia as cause for APH
Team coordination to facilitate rapid delivery

This is a useful scenario to combine with neonatal team, resuscitation training (grossly anaemic, flat neonate for resuscitation).













































Suggested learners (to represent their normal roles) In the room from the start Available when requested
Anaesthetic CT2/ST3+ √
Obstetric ST3+ √
Midwife Coordinator √
Midwife in room √
Full theatre team, Operating Department Practitioner (ODP)/anaesthetic nurse and scrub team √
*Neonatal emergency team √
Suggested facilitators
Faculty to play role of student midwife giving handover at time of emergency buzzer √


Details for Facilitators



Patient Demographics









Name: Sarah


Age: 28


Gestation: 39+5


Booking weight: 75 kg


Parity: P1 (Prev NVD)



Scenario Summary for Facilitators



Patient admitted to delivery suite for remifentanil PCA analgesia in labour 2 hours ago. Contracting 4 in 10. Fit and well. Mild asthma, previous normal vaginal delivery.


Student midwife covering for a break.


Patient commences with PV bleed in labour and sudden-onset fetal bradycardia.


Emergency buzzer activated. Team arrive.


When examined, patient found to be 6 cm dilated, 150 ml blood loss on inco sheet, fetal heart rate 80 bpm.


Uneventful antenatal history. Her 21-week anomaly scan reported no fetal abnormalities with a posterior placenta, clear of the os.


Patient continues to bleed PV, sustained fetal bradycardia for 5 minutes.


Transferred to theatre for emergency category 1 caesarean section.


Uneventful intubation and delivery of fetus. Found to have velamentous insertion of umbilical cord and white flat fetus at delivery.



Set-up Overview for Facilitators

























  • Clinical setting


  • On delivery suite in a delivery bed




  • Patient position


  • Semi-recumbent




  • Initial monitoring in place


  • Saturation monitoring




  • Other equipment


  • Remifentanil PCA (set as per local protocol) via 20G cannula



  • 16G cannula in other hand, IV Hartmann’s attached and running at 80 ml/h



  • Blood stained inco sheets




  • Useful manikin features


  • PV bleed



  • Intubation



Medical Equipment


For core equipment checklist see Chapter 9.











Additional equipment specific to scenario



  • Drugs



  • Drugs for intubation



  • Syntocinon



  • Syntocinon infusion



  • Tranexamic acid



Information Given to the Learners













  • Emergency buzzer goes off, SBAR handover from student midwife to responding obstetrician, anaesthetist and midwife.




  • Time: 16:00



  • Situation: This is an emergency! The patient has started bleeding PV and there is a fetal bradycardia.



  • Background: 28-year para 1. Admitted in early labour. Midwifery-led care but on CDU for remifentanil which she started at 14:00. She has just ruptured her membranes and I noticed some PV bleeding and the fetal heart rate has been at 80 bpm for the last minute. She is contracting 4 in 10. Last examination was 2 hours ago, cervix was 4 cm dilated, membranes present and –2 above the spines.



  • Assessment: I have called for help and checked the CTG is not recording maternal pulse.



  • Recommendation: Please can you take over her care now?

Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. 6 – Introduction to Human Factors and Ergonomics in Obstetric Simulation
  2. 13 – Minimising Decision to Delivery Interval (DDI) in a Category 1 Caesarean Section – Pre-Theatre Phase
  3. 18 – HELLP Syndrome with Fetal Compromise Requiring an Emergency GA Caesarean Section
  4. 36 – Obstetric Trauma

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 24, 2020 | Posted by in OBSTETRICS | Comments Off on 26 – Vasa Praevia

Full access? Get Clinical Tree
Get Clinical Tree app for offline access