A 26-year-old primigravida with vasa praevia (type I — vessels crossing the internal os) is diagnosed antenatally on transvaginal Doppler ultrasound at 22 weeks. The recommended management plan is:
- A Immediate delivery by emergency cesarean section at diagnosis
- B Elective cesarean section at 34–35 weeks after antenatal corticosteroids at 32–34 weeks; hospitalisation from 30–32 weeks ✓
- C Planned vaginal delivery with continuous electronic fetal monitoring
- D Conservative management with bed rest at home until 39 weeks, then elective LSCS
Correct answer: B. Elective cesarean section at 34–35 weeks after antenatal corticosteroids at 32–34 weeks; hospitalisation from 30–32 weeks
Explanation
Antenatally diagnosed vasa praevia carries a perinatal survival rate of > 95% with planned management, compared to < 50% with emergency management. Current RCOG/SMFM guidelines recommend inpatient care from 30–32 weeks (to enable immediate delivery if rupture occurs), antenatal corticosteroids at 32–34 weeks for fetal lung maturity, and elective cesarean section at 34–35 weeks to prevent membrane rupture and catastrophic fetal haemorrhage from vessel laceration. Vaginal delivery is absolutely contraindicated.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.