A peculiar case of vasa previa: Placental lake and fetal bridge vessel

Dear Editor, We found worth sharing a particular case of vasa previa with velamentous insertion of the umbilical cord, in a nulliparous woman with voluminous placental lakes, that recently occurred at our clinic. The Patient was referred to our center for suspected placenta previa. At the transvaginal ultrasound performed at 22 weeks of gestation, the placenta appeared predominantly posterior with a small anterior accessory lobe; a voluminous placental lake characterized by low velocity flow on 2D-grey scale was noted, with velamentous insertion of the umbilical cord on its posterior portion (Fig. 1, Supplementary videos 1 and 2). Cord vessels were seen running above the cervix, forming a peculiar “bridge” between the anterior and posterior portion of the placental lacuna, also visible at 3D reconstruction (Supplementary figure 1). These findings were confirmed during third trimester ultrasound evaluation. The patient was hospitalized at 33 weeks of gestational age and underwent an elective caesarean section, after a course of steroids for lung maturation, at 36 weeks. A newborn of 2570 g, with normal umbilical cord gas analysis and an Apgar score after 5 min of 10, was delivered. Intraoperative blood loss was within normal limits. Fetal bridge vessels running across the membranes were visible after placental removal (Supplementary figure 2) and the diagnosis of vasa previa was confirmed.