Dr Anne Gribble1,2, Dr Georgina Facchetti3, Ms Elizabeth Kerle1, Dr Wanyu Luk1
1Illawarra Shoalhaven Local Health District, Wollongong, Australia, 2University of New South Wales, Kensington, Australia, 3Nepean Blue Mountains Local Health District, Kingswood, Australia
Biography:
Anne is a junior doctor working in Obstetrics and Gynaecology. She graduated from Sydney Medical School in 2020 and is now studying a Masters of Public Health. Her previously published research focusses on Mediterranean diet and lifestyle, including siesta, coffee consumption and exercise intensity. She speaks English, French and Spanish.
Abstract:
Introduction: Furcate placenta is a rare obstetric finding, reported to occur in approximately 0.1% of pregnancies (1). It refers to the separation of the umbilical cord vessels prior to insertion into the placenta. The separated vessels are not protected by Whartons jelly and are therefore thought to have increased risk of thrombosis, compression, aneurysm or rupture (1,2). If furcate cord insertion is identified on antenatal ultrasound, the recommended management is to deliver at 37 weeks (1, 2). However, given that reports of furcate placenta are so rare, the evidence base that underpin this recommendation for significant intervention is limited. Meanwhile, ultrasound technology is increasingly able to identify furcate umbilical cord insertions antenatally, so it is important to consider learnings from all cases to guide management decisions.
Case Presentation: A furcate umbilical cord insertion was discovered on routine review of placenta following a spontaneous normal vaginal delivery at 39+6 weeks gestation in a 37 year old primigravid woman with IVF pregnancy and gestational diabetes. Furcate cord insertion had not been discovered antenatally, though the woman had a marginal cord and low-lying anterior placenta reported on first trimester scan and a central insertion reported at 20 week morphology. Intrapartum, the birth was midwife managed, with continuous external fetal monitoring and no fetal distress detected. The total duration of labour and birth was almost 14 hours. Blood loss was 700 millilitres, mainly due to bleeding from episiotomy site. The baby developed post-natal jaundice that did not require intervention, but no other concerns were identified.
Conclusion: This is a case of incidental finding of furcate placenta with nil complications following spontaneous labour and vaginal birth at full term. Further research is needed to guide recommendations for management of furcate placenta as too are standard protocols for ultrasound examination of placental cord insertion.
Keywords
Furcate placenta
References
1. Kosian, P. et al. Furcate insertion of the umbilical cord: Pathological and clinical characteristics in 132 cases. Journal of Perinatal Medicine. 2020; 48(8):819–824.
2. Smet, M.E. et al. Furcate cord insertion: Under‐reported but likely relevant. Ultrasound in Obstetrics & Gynecology. 2024; 63(2): 280–281.