Cervical Cerclage Prevents Umbilical Cord Prolapse in Cases with Persistent Funic Presentation

Objective: The prolapse of the umbilical cord complicates 1 in 200–400 pregnancies and has been associated with high perinatal morbidly and mortality. A funic presentation is a known risk factor for umbilical cord prolapse. The current management of funic presentation consists of frequent sonographic examinations which enhance maternal anxiety and does not prevent umbilical cord prolapse. We propose a new approach- the placement of a third-trimester cervical cerclage in women with persistent funic presentation. To provide mechanical barrier to umbilical cord prolapse.

Methods: When a funic presentation was detected, the follow-up sonographic examination was performed a week later to confirm its persistent nature. 14 patients between 26 and 35 weeks of pregnancy, with a mean of 39+3 weeks of pregnancy, underwent cervical cerclage. Four to six bites of the needle were required to encircle the cervix, depending on its thickness.

Results: All patients were delivered by a cesarean section between 34(with preterm PROM) and 39 weeks. None of the patients experienced prolapse of the umbilical cord. Funic presentation was confirmed at birth in all cases. Cervical cerclage was removed at delivery without complications.

Conclusion: Currently there is no strategy to prevent umbilical cord prolapse in mothers with persistent funic presentation. In view of a total lack of preventative measures in cases of persistent funic presentation, the placement of cervical cerclage appears as a reasonable strategy. Because persistent Funic presentation is rare a multicenter prospective study on efficacy of cervical cerclage is needed.

Publication History

Article published online:
17 September 2021