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

IMPORTANCE: Furcate umbilical cord insertion is a rare anomaly in which the umbilical vessels separate and lose Wharton jelly before placental insertion. This condition increases the risk of complications such as vessel avulsion and intrauterine fetal demise (IUFD). Despite these risks, data on this condition are limited, and no formal management guidelines exist for prenatally diagnosed cases. OBJECTIVE: To provide an overview of abnormal umbilical cord insertions, with a focus on furcate cord insertions, as well as the evidence for the management of patients with furcate cord insertions. EVIDENCE ACQUISITION: Articles were identified through a PubMed and OVID literature search and reviewed for relevance. RESULTS: We identified 158 cases of furcate cord insertion. Prenatal diagnosis occurred in only 20 cases (12.7%). IUFD was reported in 6 cases (3.8%), all where furcate cord went undiagnosed prenatally and nearly all (5/6) occurring after 37 weeks' gestation. Cesarean delivery was frequently performed when furcate cord insertion was detected prenatally, especially when co-occurring other comorbidities. Cord avulsion was reported in all cases of labor after 37 weeks, underscoring the risks associated with vaginal delivery. CONCLUSION: Furcate cord insertion is a rare placental anomaly associated with significant perinatal risk. Improved prenatal recognition may support evidence development and guide peripartum care. According to the limited available evidence, early-term cesarean delivery may be a reasonable option in prenatally diagnosed cases, though further research is needed. RELEVANCE: This review offers an overview of the evidence for the detection and management of furcate cord insertions.

Duke Scholars

Author Jeffrey Adam Kuller Obstetrics and Gynecology, Maternal Fetal Medicine

Author Sarah K. Dotters-Katz Obstetrics and Gynecology, Maternal Fetal Medicine