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. However it is concerning if persistent, and it is then recommonded that an underlying cause be sought and precautionary management implimented.
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 C 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
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- 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