Endovascular Management of a Large Persistent Sciatic Artery Aneurysm.

The persistent sciatic artery (PSA) is a remnant of the fetal circulatory system that is preserved in less than 0.1% of the population. Up to 60% of patients with this vascular anomaly will go on to development of a PSA aneurysm (PSAA), which can produce a variety of symptoms including neuropathy, claudication, and acute limb-threatening ischemia. Historical management is by open operation and interposition grafting, which can be highly morbid. We describe successful management of a large, symptomatic PSAA by endovascular stent grafting with intermediate term follow-up.

[Vasa previa: one case]. / Vasa praevia: à propos d'un cas.

Vasa previa is a rare condition (1/2000 to 1/5000) in which the rupture of membranes may result in fetal haemorrhage (Benckiser's haemorrhage). We report one unusual case of delayed Benckiser's haemorrhage 12 hours after rupture of membranes. We point out the risk situations in which prenatal diagnosis should particularly be sought: low-lying placenta at routine second trimester ultrasound screening, bilobate or succenturiate placenta, velamentous insertion of the umbilical cord, in vitro fertilization. A universal screening, as proposed by certain authors, is also discussed.

The role of light and sound technologies in the detection of vasa praevia.

Velamentous vessels across the internal os are rare (1 in 5000) but the high perinatal mortality (50-70%) has not improved with traditional methods of detection. In late pregnancy, Low Intrauterine Transcervical Endoscopy (LITE) can aid detection. Using LITE, such vessels have been 'seen' in 3 of 5000 patients examined; one case was detected fortuitously in 2500 patients examined during 1965-70, and two were detected in a special subgroup from 2500 patients examined during 1971-89 in which LITE was performed prior to labour with the express aim of excluding vasa praevia. Detection occurred before labour and in the absence of antepartum haemorrhage. In all three cases, the cervix was not dilated beyond 1 cm and a single velamentous vessel was found. The absence of labour and haemorrhage probably contributed to a zero perinatal mortality. Recently, ultrasound has been used in the detection of vasa praevia. Combination of abdominal real-time ultrasonography with LITE has permitted comparison of the efficacy of these two techniques; two of the patients with vas praevium were ultrasound negative but LITE positive. The risk of vasa praevia should be considered (a) when ultrasonography has shown a bilobed or succenturiate placenta, a low-lying placenta where the cord has a battledore insertion, a migrating placenta, or a suspicion of velamentous vessel traversing the internal os, (b) when there is a multiple or IVF pregnancy, or (c) when there is intrapartum bleeding or an irregularity in fetal heart rate. Inexperienced practitioners using LITE risk the rupture of a vas praevium. However, efficiently performed for those patients at increased risk of fetal hypoxia, or to detect meconium pollution of the amniotic sac or prior to amniotomy, LITE may fortuitously reveal a vas praevium and thereby enable action that prevents iatrogenic or spontaneous rupture.

[Diagnosis of vasa praevia by amnioscopy. Value of induced labor. A case report]. / Diagnostic d'un vaisseau praevia par l'amnioscopie. Intérêt de l'accouchement programmé. A propos d'un cas.

The authors report a case of vessel praevia diagnosed at routine examination prior to the induction of labour. They emphasize the dramatic risk of very serious hemorrhage occurring after rupture of the membranes and the value of prophylactic caesarean section once the diagnosis is known. Routine use of amnioscopy in determining whether the timing of labour is appropriate and the increased alertness which this imposes to the obstetrician appear to be the only method for the prevention of these dramatic complications. In the future, colour Doppler will offer an earlier diagnostic method.