Background and Aims Vasa previa is a rare condition where umbilical blood vessels cross the cervical os with abnormal membranous insertion into the placenta. It’s a cause of peripartum haemorrhage and the foetus can exsanguinate within minutes during membrane rupture. When diagnosed antenatal caesarean delivery is scheduled and a catastrophic foetal haemorrhage can be prevented. For non-urgent delivery, neuro-axial techniques are preferable since the second foetus in gemelar gestations is at greater risk of exposure to anaesthetic agents.

Methods This case reports a 32-year-old nulliparous woman with a twin pregnancy complicated with an ultrasound diagnosis of vasa previa at 22 weeks of gestation. She was admitted to the obstetric unit at 30 weeks for surveillance and foetal lung maturation. A caesarean delivery was scheduled at 32 weeks and foetal matching blood units were available, if required. Under ASA standards monitoring, a combined spinal-epidural technique was performed at L3-L4 with intrathecal administration of 0.5% levobupivacaine and sufentanil. Epidural morphine and 0.2% ropivacaine were administered for postoperative analgesia.

Results Both twins were born healthy with an Apgar score of 9, 9 and 10 at 1, 5 and 10 minutes respectively and were transferred to the neonate unit. The procedure occurred without any significant maternal and foetal bleeding.

Conclusions Membrane rupture in vasa previa requires an emergent caesarean with general anaesthesia due to acute foetal distress. This case highlights the huge impact of the antenatal diagnosis with consequent elective caesarean on favourable foetal outcomes allowing a safe loco-regional technique, in particular on gemelar gestations.