A cord presentation (also known as a funic presentation) is a variation in 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 recommonded that an underlying cause be sought and precautionary management implemented.
The estimated incidence is at ~4% of pregnancies
Recognised 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
- multifetal pregnancy
- long umbilical cord
Colour Doppler interrogation is extremely useful and shows cord between the fetal presenting part and the internal cervical os. However unlike a vasa praevia, the placental insertion is usually normal.
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 caesarean section delivery to 3rd trimester persistent cord presentation 3.
For the presence of umbilical cord vessels between the fetal presenting part and the internal cervical os on ultrasound consider
- 1. Ezra Y, Strasberg SR, Farine D. Does cord presentation on ultrasound predict cord prolapse? Gynecol. Obstet. Invest. 2003;56 (1): 6-9. doi:10.1159/000072323 - Pubmed citation
- 2. Kinugasa M, Sato T, Tamura M et-al. Antepartum detection of cord presentation by transvaginal ultrasonography for term breech presentation: potential prediction and prevention of cord prolapse. J. Obstet. Gynaecol. Res. 2007;33 (5): 612-8. doi:10.1111/j.1447-0756.2007.00620.x - Pubmed citation
- 3. Raga F, Osborne N, Ballester MJ et-al. Color flow Doppler: a useful instrument in the diagnosis of funic presentation. J Natl Med Assoc. 1996;88 (2): 94-6. - Free text at pubmed - Pubmed citation
- 4. Bluth EI. Ultrasound, a practical approach to clinical problems. Thieme Publishing Group. (2008) ISBN:3131168323. Read it at Google Books - Find it at Amazon