Ruptured vasa praevia in birth suite — emergency management station

Team-based emergency station: ruptured vasa praevia with fetal exsanguination. Tests immediate recognition of the fetal-bleeding-well-mother pattern, category-1 declaration without confirmatory testing, closed-loop team leadership, pre-ordering emergency group O RhD-negative red cells, directing neonatal volume resuscitation, and communicating with a frightened woman. Includes assessor timeline, marking domains, assessor key and fail criteria.

Prompt

It is 02:50 on birth suite. A 30-year-old G2P1 at 35 weeks and 4 days, with vasa praevia diagnosed at 22 weeks and awaiting a scheduled caesarean at 36 weeks, has had spontaneous rupture of membranes ten minutes ago. There is 120 mL of fresh red blood on the pad and the flow is continuing. She is pain free. Pulse 88 bpm, blood pressure 122/76 mmHg, respiratory rate 16, alert. The cardiotocograph shows the fetal heart rate falling from 150 to 65 bpm with no recovery. You are the registrar. The consultant is at home, 20 minutes away.

Station brief

Format. Emergency management station, approximately 12 minutes, with 4 minutes reading. You are the obstetric registrar on birth suite. A midwife, a midwifery coordinator and a duty anaesthetist are available. The consultant obstetrician and the neonatal registrar are both contactable. The assessor runs the clock and feeds observations. ^[1]

Candidate instruction. Lead the management of this emergency. Verbalise every action, every order with its dose, your escalation, and your communication with the team, the neonatal service and the woman. ^[1]^[5]

References7Show

[1]Jauniaux E, Alfirevic Z, Bhide AG, et al. Vasa Praevia: Diagnosis and Management: Green-top Guideline No. 27b BJOG, 2019.PMID 30260094
[2]Oyelese Y, Catanzarite V, Prefumo F, et al. Vasa previa: the impact of prenatal diagnosis on outcomes Obstet Gynecol, 2004.PMID 15121568
[3]Oyelese Y, Javinani A, Shamshirsaz AA Vasa Previa Obstet Gynecol, 2023.PMID 37590981
[4]Nicolaides KH, Clewell WH, Rodeck CH Measurement of human fetoplacental blood volume in erythroblastosis fetalis Am J Obstet Gynecol, 1987.PMID 3605267
[5]Lee HC, Strand ML, Finan E, et al. Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation, 2025.PMID 41122887
[6]Sankaran D, Vali P, Giusto E, et al. Randomised trial of early rapid saline bolus versus epinephrine during resuscitation in perinatal haemorrhagic cardiac arrest in newborn lambs Arch Dis Child Fetal Neonatal Ed, 2026.PMID 41819786
[7]Heyborne K Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa: A Systematic Review Obstet Gynecol, 2023.PMID 37535966

Ruptured vasa praevia in birth suite — emergency management station

Station brief

References7Show

[1]Jauniaux E, Alfirevic Z, Bhide AG, et al. Vasa Praevia: Diagnosis and Management: Green-top Guideline No. 27b BJOG, 2019.PMID 30260094
[2]Oyelese Y, Catanzarite V, Prefumo F, et al. Vasa previa: the impact of prenatal diagnosis on outcomes Obstet Gynecol, 2004.PMID 15121568
[3]Oyelese Y, Javinani A, Shamshirsaz AA Vasa Previa Obstet Gynecol, 2023.PMID 37590981
[4]Nicolaides KH, Clewell WH, Rodeck CH Measurement of human fetoplacental blood volume in erythroblastosis fetalis Am J Obstet Gynecol, 1987.PMID 3605267
[5]Lee HC, Strand ML, Finan E, et al. Part 5: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Circulation, 2025.PMID 41122887
[6]Sankaran D, Vali P, Giusto E, et al. Randomised trial of early rapid saline bolus versus epinephrine during resuscitation in perinatal haemorrhagic cardiac arrest in newborn lambs Arch Dis Child Fetal Neonatal Ed, 2026.PMID 41819786
[7]Heyborne K Perinatal Mortality Despite Prenatal Diagnosis of Vasa Previa: A Systematic Review Obstet Gynecol, 2023.PMID 37535966