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Background and Aims Vasa previa is a rare but potentially life-threatening condition to the fetus, where blood vessels traverse the lower uterine segment, risking rupture. Fetal mortality for unrecognized cases is at least 60% despite urgent cesarean section (CS). Antenatal diagnosis and elective CS between 34-35 weeks of gestation can improve fetal outcomes.

Methods A 34-year-old woman, G2P1A0, was admitted through emergency services at 34+3 weeks of gestation in active labor. She was clinically stable without active hemorrhage. A transvaginal ultrasound on admission day revealed a viable singleton fetus with velamentous cord insertion 2 cm away from the internal os, and fetal blood vessels running across the cervix, making the diagnosis of vasa previa. Anesthesiology and neonatal teams were immediately contacted. It was decided to proceed with an urgent CS using a combined spinal-epidural anesthetic technique. The patient was prepared for the risk of intraoperative hemorrhage and the potential need for general anesthesia. The immunochemotherapy service was notified. The fetus was delivered after careful separation of the membranes avoiding vessel damage. There was no postpartum hemorrhage. The baby, with APGAR scores of 6, 8, and 9, was admitted to the neonatal intensive care unit due to prematurity and discharged after 14 days.

Results The diagnostic of vasa previa, especially during the onset of labor, poses a complex challenge. It can be fatal for the fetus due to compression of fetal blood vessels during uterine contractions. This case highlights the importance of a multidisciplinary approach, where timely and effective interventions significantly improve maternal and fetal prognosis.