Vasa previa a subject that hit close to home for us Updated with link

Although Brynn is almost four and a half months old and I have yet to get off my lazy butt and write our birth story, I have gotten off my lazy butt enough to write about a subject that has hit close to home for us. Even though I am a nurse anesthetist and have worked in the medical field in some capacity for over a decade now, I wasn't really all that familiar with the phrase "vasa previa" until the delivery and birth of our daughter Brynn. I feel I must look at this subject before I can move forward. Until I face where we have been, I can't begin to move forward with our journey towards adding to our family.

I won't go into too much detail because this would be too long of a post, but on November 7th, 2008 my labor was induced a month and a half early due to a reverse peristalsis that was starting to harm the life of both myself and my unborn daughter. I had lost 25 pounds or so and Brynn was falling farther and farther behind on her growth. An amniocentesis had shown her lungs to be mature so we received the green light go for an induction for a vaginal delivery. Our daughter was conceived via IVF and although I had a complete previa most of my pregnancy - it had now moved. Due to the risk of requiring a classical versus lower transverse incision if a c section was done (necessitating a c section and risk of uterine rupture with future pregnancies) due to my unicornuate uterus - an attempt at a vaginal birth seemed prudent. (Lower uterine segments are often underdeveloped in people with this uterine abnormality, especially when the baby is being delivered prematurely, so a classical c section is more likely than the normal population to be necessary.)

After a standard induction with pitocin, my OB had decided to break my water to get things moving. He had the hook in one hand, and checked my cervix for dilation with the other. Before he could break my water with the hook, my water broke on it's own. This very occurance saved my daughter's life. At the time we were clueless as to what was going to happen. Ignorance was truly bliss. If he had broken my water with the hook (something that is usually completely safe to do), my daughter would likely have died. Soon later, after my epidural was bolused by my coworker, I began to experience sudden relief, but Brynn's heart tones took a dive and stayed low for a few minutes. Before my labor and delivery nurse could tell me what to do, I flipped on my left side and looked for my simple mask that would quickly be thrown on my face to try to remedy the situation. After inserting hundreds of epidurals myself and seeing this happen sometimes, I knew the drill. These two manueuvers helped and Brynn's heart tones recovered. In a matter of minutes I felt the need to have a large bowel movement and I knew I was fully dilated in minutes. My OB rushed in and Brynn's delivery was done in a matter of minutes, three or four pushes and she was out. We were all thankful because during the brief time I was pushing Brynn's heart rate dropped to dangerously low levels. So much that I had a few more pushes and then we would be wisked off for an emergency C-section. All heart rates drop somewhat during deliveries, but Brynn's was very low - something was wrong.

Brynn was being examined by the NICU team and crying vigorously - her Apgar scores were wonderful and she was doing great. She would be examined and monitored by the NICU team, but she was fine..healthy...perfect. No major problems...breathing room air and having scores of 9. Next my OB delivered the placenta...I heard "Oh wow" come from beneath my legs. The room was silent. This is what we saw. Sorry for the graphic photos.


My heart sank, I wondered what was wrong...what was going on down beneath my legs..what on earth was happening. My OB whispered..."you have a vasa previa, I haven't seen one since 1995." Brynn's heart rate had dropped after the epidural bolus and during pushing because of this vasa previa. This placenta was almost bigger than my four pound daughter. Her descent down the birth canal had caused the vessels of her placenta, her major lifeline to my oxygen and nutrient supply to leak, depriving her of oxygen. She was slowly beginning to bleed to death. If she had not been delivered in minutes she would likely have died. Also, scary as that seemed....to compound the fact.....I could have began to bleed to death as well. But somehow...by some miracle and absolute grace of God, and skilled work of my OB and peri...we were both fine.

Looking over at Brynn screaming and crying with vigor under the care of the neonatologist, protesting their exam, basically being as healthy as a newborn could be I was silent. I wanted to laugh with joy, I wanted to vomit with fear, I wanted to cry...oh gosh I was shaking. How could this be, how could we be so unlucky again. I pulled the unicornuate uterus odds (1 in 6000) and now this? But quickly I realized I was blessed....how could we be this LUCKY? Things were fine...how could this be? The placenta was wisked off to pathology, with the results coming back a few days later. "Fetal demise". The pathologist said that due to the condition of this placenta, the vessels and the leakage of blood and fluid the results were fetal death. But no...Brynn was fine. Alive and in my arms when I heard the news. I cried. She was my miracle. I held her so close that I was afraid I was smoothering her. I didn't want to let go, even for a second. I had come so close to losing my miracle I had waited 3 years for. Dear God..how could this have happened, or rather... not happened?

Most people may not know what a vasa previa is. Heck most of my coworkers were unaware of what a vasa previa is. Vasa previa is a rare (1:5000), devastating condition in which the fetal blood vessels, unsupported by either the umbilical cord or placental tissue, cross the fetal membranes (bag of water) across the bottom of the uterus between the baby and the cervical opening. The condition has a very high fetal mortality rate (80-100%) due to fetal exsanguination (bleeding) resulting from fetal vessels tearing when the amniotic membranes rupture (your water breaks) or because the vessels become pinched off as they are compressed between the baby and the walls of the birth canal. Basically, the vessels that should be inside the placenta are exposed - kind of like exposed electrical wire. They loop down near the vaginal opening or opening of the cervix. When it is time for the baby to come out the baby has no choice but to break through these vessels leading to their rupture and bleeding. Within minutes both baby and mom can bleed and die. Also, when the water is broken with the hook used by most OBs, the hook is almost certain to rupture these vessels because they stand in the way of breaking the amniotic sac or "the mother's water." That is why had my OB broken my water instead of me spontaneously breaking my water on my own, Brynn would have likely died.

I'm excited to say that I'm becoming involved in the International Vasa Previa Foundation. I have since learned that when screened for, vasa previa is almost 100% detectable and when measures are taken....poor outcomes can be prevented. The problem being is that in this country screening is not routine, covered by insurance often, or even addressed because it is such a rare condition. But the really sad thing is that women who have undergone IVF are some of the people most at risk for whatever reason. So I will continue to talk about whatever happened to us to whoever will listen. I'll talk because it's a situation that can be treated, it's a situation that some of us in the infertility community are at risk for, and it's a situation that need not claim the life of any other babies. Somehow, by some miracle we were spared...but many are not and dear God it's my goal to make sure no mother needs to go through that. So ifyou're not too bored, I'd like to continue to talk about this subject on my blog here...risk factors, what it is and what can be done. I want to and need to talk about it. For Brynn's sake I need to...it's the least she deserves. So thank you for listening....you're the best. Because Brynn every breath you have taken, every smile you have given me is a gift....a gift we might not have had and are certainly not one I will ever take for granted.

If you or anyone else has been touched by this condition I would love to hear your story if you're willing to share. Geohyde (J) thanks for sharing the link to this story. I have seen it but will include it to share for others. More stories are here. My heart aches for those who have not have the same outcome...especially since it is totally preventable.