A cord presentation (also known as a funic presentation or obligate cord 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 is usually considered insignificant until ~32 weeks. It is concerning if it persists past that date, after which it is recommended that an underlying cause be sought and precautionary management implemented.
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Epidemiology
The estimated incidence is at ~4% of pregnancies.
Associations
Recognized associations include:
marginal cord insertion from the caudal end of a low-lying placenta
congenital uterine anomalies that may prevent the fetus from engaging well into the lower uterine segment
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.
Treatment and prognosis
As the complicating umbilical cord prolapse can lead to catastrophic consequences, most advocate an elective cesarean section delivery for persistent cord presentation in the third trimester 3.
Complications
It can result in a higher rate of umbilical cord prolapse.
Differential diagnosis
For the presence of umbilical cord vessels between the fetal presenting part and the internal cervical os on ultrasound consider:
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