Funic presentation (also known as cord presentation) is a rare entity with an incidence that ranges from 0.006% to 0.16% in the third trimester scans (Ezra et al., Gynecol Obstet Invest 2003; 56: 6–9. 2003) and is defined as the presence of the cord between the presenting part of the fetus and the internal cervical os, with or without intact membranes (“Umbilical Cord Prolapse (Green-top Guideline No. 50) | RCOG,” n.d.). It may be a transient phenomenon and is usually considered insignificant until ~32 weeks. However, its persistence beyond that gestational age raises the concern of cord prolapse during labor as cervical dilation progresses. Consequently, current bibliography recommends Caesarean delivery when funic presentation is detected during labor making antenatal ultrasound detection a valuable asset in the effort to prevent the complications that cord prolapse has been associated with (Jones et al., BJOG 2000; 107: 1055–7 ). Cord prolapse is the most significant complication of funic presentation and as such, the antenatal detection of cord presentation cases and the determination of patients that carry an increased risk for UCP are of paramount importance.

It 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 (occult prolapse) the fetal presenting part in the presence of ruptured membranes. The reported incidence of umbilical cord prolapse ranges from 1 to 6 per 1000 pregnancies (Faiz et al., Saudi Med J 2003; 24: 754–7).Though rare, it is associated with high perinatal mortality and morbidity as cord compression and umbilical artery vasospasm may occur preventing blood flow to and from the fetus leading to fetal asphyxia (Critchlow et al., Am J Obstet Gynecol 1994; 170: 613–8).

A 30-year-old pregnant woman at 32+2 weeks of gestation, gravida 5, para 4, presented to the outpatient clinic of our institution during the third trimester of her pregnancy, due to painless vaginal bleeding. The antenatal course had been otherwise uncomplicated. The woman’s past medical history was uneventful.

During her pregnancy, she underwent no prenatal testing except for a first trimester scan at 9 weeks of gestation where the exact gestational age was determined.

She had previously had four uncomplicated pregnancies, having delivered vaginally the first two, while the third and the fourth pregnancies were delivered via caesarean section – the first one because of a footling breech presentation and the other one because of the previous caesarean section. The woman was hemodynamically stable, and the biophysical profile was normal.

All fetal growth parameters, the amniotic fluid index and the Doppler assessment were within normal range for the gestational age (EFW: 2342gr (89th percentile)).

A single course of antenatal corticosteroids was given at 32+2 and 32+3 weeks of gestation, due to the fear of an impending umbilical cord prolapse.

The pregnancy was followed up with weekly ultrasound scans. The free loops remained in close proximity to the internal os, lying between the presenting part and the cervix. The pregnancy was monitored until 36+0 weeks of gestation, when the patient began complaining of regular contractions, a fact that was confirmed with the use of cardiotocography. A new ultrasound examination was performed with the umbilical cord loops still present between the fetal head and the cervix and an emergency caesarean section was performed.