Funic Presentations at Term: CS or Not? Timing?

Funic presentation, the umbilical cord presenting as the leading feal component seen on ultrasound, may be a transient phenomenon and is usually considered insignificant until ~32 weeks. However, its persistence beyond that gestational age raises the possibility of cord prolapse intrapartum as cervical dilation progresses. Cord prolapse is a mostly unpredictable obstetric emergency, in which the umbilical cord comes through the cervical os in advance of (overt prolapse – usually palpable or even visible within the vagina) or alongside the fetal presenting part in the presence of ruptured membranes (occult prolapse). The reported incidence of umbilical cord prolapse ranges from 1 to 6 per 1000 pregnancies. Though rare, cord prolapse is associated with high perinatal mortality and morbidity as cord compression and umbilical artery vasospasm may occur preventing blood flow. Consequently, expert opinion recommends CS when funic presentation is detected INTRAPARTUM. But WHEN is delivery recommended a funic presentation is found in the late third trimester? Does that need a CS? Funic presentation is notably absent from the ACOG CO 831 on medically indicated late preterm and early term deliveries. Listen in for details.