What immediate management steps should be taken if vasa praevia is sus

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

If vasa praevia is suspected during labour, the immediate management steps include:

Transfer the woman to obstetric-led care immediately to ensure access to specialist resources and continuous monitoring .
Establish venous access promptly to allow for rapid fluid resuscitation if bleeding occurs .
Start continuous cardiotocography (CTG) to monitor the fetal heart rate continuously, as fetal compromise can occur rapidly .
Monitor maternal vital signs closely and assess vaginal blood loss carefully, distinguishing it from a normal show .
Take blood samples urgently for full blood count, blood group, and cross-matching in preparation for possible transfusion .
Seek immediate senior obstetric and anaesthetic advice and involve a multidisciplinary team including senior midwife and labour ward coordinator to plan urgent delivery .
Prepare for expedited birth, usually by emergency caesarean section, to prevent fetal exsanguination due to ruptured fetal vessels .
Administer intravenous fluids urgently if there is significant bleeding or maternal instability .

What immediate management steps should be taken if vasa praevia is suspected during labour?