In women with vasa praevia type II (associated with a succenturiate lobe), at what gestational age does the Society for Maternal-Fetal Medicine (SMFM) 2020 recommend elective caesarean delivery in the absence of bleeding?

• A 34–35 weeks after corticosteroid administration ✓
• B 36–37 weeks after corticosteroid administration
• C 38–39 weeks without corticosteroids
• D At the onset of labour regardless of gestational age

Explanation

For vasa praevia (both type I — associated with velamentous cord insertion, and type II — associated with succenturiate lobe), SMFM 2020 guidelines recommend elective caesarean delivery at 34–35 weeks of gestation, with antenatal corticosteroids administered prior to delivery to enhance fetal lung maturity. The rationale is to prevent fetal exsanguination from rupture of unprotected fetal vessels at membrane rupture. Waiting until 36–37 weeks or later significantly increases the risk of unexpected labour onset and catastrophic vessel rupture.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.