Furcate Cord Insertions: A Comprehensive Review of Reported Cases, Outcomes, and Management Implications

Area of Science:

• Obstetrics and Gynecology
• Fetal Medicine
• Perinatal Research

Background:

• Furcate umbilical cord insertion is a rare placental anomaly where umbilical vessels separate prematurely.
• This condition increases risks of fetal complications, including vessel avulsion and intrauterine fetal demise (IUFD).
• Limited data and lack of management guidelines exist for prenatally diagnosed cases.

Purpose of the Study:

• To review abnormal umbilical cord insertions, focusing on furcate cord insertions.
• To examine the evidence for managing patients diagnosed with furcate cord insertion.

Main Methods:

• Literature search conducted using PubMed and OVID databases.
• Relevant articles were identified and reviewed for inclusion.

Main Results:

• 158 cases of furcate cord insertion were identified; prenatal diagnosis in only 12.7%.
• IUFD occurred in 3.8% of cases, primarily when undiagnosed and after 37 weeks.
• Cord avulsion was noted in all labor cases after 37 weeks; cesarean delivery was common with prenatal diagnosis.

Conclusions:

• Furcate cord insertion is a rare anomaly linked to significant perinatal risks.
• Enhanced prenatal recognition is crucial for developing evidence and guiding peripartum care.
• Early-term cesarean delivery may be considered for prenatally diagnosed cases, pending further research.