cord (funic) presentation

A cord presentation (also known as a funic presentation) is a variation in the fetal presentation where the umbilical cord points towards the internal cervical os or lower uterine segment.  It may be a transient phenomenon and usually considered insignificant until ~32 weeks. It is concerning if it persists past that date, and it is then recommended that an underlying cause be sought and precautionary management implemented.

Epidemiology

The estimated incidence is at ~4% of pregnancies

Pathology

Associations

Recognized associations include

• marginal cord insertion from the caudal end of a low-lying placenta
• uterine fibroids
• uterine adhesions
• congenital uterine anomalies that may prevent the fetus from engaging well into the lower uterine segment
• cephalopelvic disproportion
• polyhydramnios
• multifetal pregnancy
• long umbilical cord

Radiographic features

Ultrasound

Color Doppler interrogation is extremely useful and shows cord between the fetal presenting part and the internal cervical os. However, unlike a vasa previa, the placental insertion is usually normal.

Complications

It can result in a higher rate of umbilical cord prolapse.

Treatment and prognosis

As the complicating umbilical cord prolapse can lead to a catastrophic consequences, most advocate an elective cesarean section delivery to 3 trimester persistent cord presentation .

Differential diagnosis

For the presence of umbilical cord vessels between the fetal presenting part and the internal cervical os on ultrasound consider

• vasa previa

Siehe auch:

• vasa praevia

und weiter:

• umbilical cord prolapse
• variation in fetal presentation