Persistent funic presentation due to velamentous cord insertion adjacent to the internal os

A report describes a case of a 43-year-old pregnant woman with a history of spontaneous vaginal delivery at term with no complications who presented at 33 weeks of gestation. She showed a placenta located at the anterior uterine wall. However, velamentous cord insertion was 5.6 cm from the internal os, with the presenting part comprising free loops of the umbilical cord. The cervical length was 2.6 cm, and the cervical canal was closed. Growth of the fetus was appropriate for the gestational age, with normal amniotic fluid volume. 

Weekly monitoring showed no increase in uterine contraction or fetal heart rate abnormality. Persistence of funic presentation prompted cesarean delivery at 38 weeks of gestation before labor onset. She also underwent an amniotomy away from the umbilical cord vessels surrounded by fetal membranes.

The patient delivered a male infant weighing 3270 g with Apgar scores of 8 and 9 at 1 and 5 min, respectively, and received a discharge on the sixth day of life without complications. Velamentous cord insertion with no rupture of umbilical cord vessels was confirmed.

Source: Taiwanese Journal of Obstetrics and Gynecology. 2020;59(1):167-168. https://doi.org/10.1016/j.tjog.2019.10.001.