LAUSR

FIGURE Gross images of vasa previa Case Notes A 31-year-old woman with previous cesarean delivery was referred to our hospital because of placenta accreta at 32 weeks of gestation. Ultrasound examination revealed a lowlying anterior placenta covering her previous cesarean scar, and we suspected placenta accreta. Marginal or velamentous cord insertion was suspected; however, definitive diagnosis was not possible by transabdominal ultrasonography because of a deeply descended fetal head. Transvaginal ultrasonography in the sagittal plane did not reveal cord vessels near the inner cervical os. Cesarean delivery was performed via transverse uterine fundal incision with subsequent supracervical hysterectomy at 36 weeks of gestation. Gross findings revealed an intact lower amniotic membrane with a cord vessel running transversely with an undiagnosed vasa previa (Figure, A and B). The uterus was incised along the posterior wall, which showed a marginal cord insertion with a cord vessel running along the amniotic membrane (Figure, C); histopathologic evaluation revealed placenta increta. The patient and infant were discharged on postoperative day 8 without complications.