Fetal bradycardia and vasa previa in a pregnant woman with insulin resistance: A case report

Bradicardia fetal y vasa previa en gestante con resistencia a la insulina: Reporte de caso

Abstract

Introduction: Vasa previa is a rare but potentially catastrophic obstetric condition characterized by the presence of fetal vessels running through the fetal membranes without the protection of Wharton's jelly. Timely prenatal diagnosis significantly reduces perinatal mortality; however, atypical presentations may occur. Case report: We report the case of a 26-year-old primigravida with a history of insulin resistance and Class I obesity, who presented at 28.3 weeks of gestation with severe fetal bradycardia in the absence of vaginal bleeding. Monitoring revealed a non-reassuring fetal heart rate pattern with decelerations reaching 83 bpm. Betamethasone was administered for fetal lung maturity and magnesium sulfate for neuroprotection. Due to persistent fetal compromise, an emergency cesarean section was performed. Intraoperatively, a velamentous cord insertion was identified with exposed fetal vessels consistent with vasa previa and a peri-insertional hematoma. A preterm newborn weighing 1200 g was obtained, with an Apgar score of 8 and 9 at the first and fifth minute, respectively. Maternal recovery was favorable. Conclusions: Isolated fetal bradycardia can be a sentinel manifestation of vasa previa, even without bleeding. A high index of suspicion and timely obstetric intervention are fundamental to improving perinatal outcomes. Keywords: Vasa Previa; Cesarean Section; Pregnancy, High-Risk (Source: MeSH, NLM).