Furcate and Velamentous Cord Insertion: Prenatal Ultrasound

Nupur Shah¹

Dr. Nupur Shah is a Consultant fetal medicine and prenatal genetics.
Nupur Shah nupurmshah@gmail.com

1 Baroda Imaging Centre, Alkapuri, Vadodara, Gujarat 390007, India

Nupur Shah Dr Nupur Shah is a consultant fetal medicine and prenatal genetics, practicing in Baroda, Gujarat. After her postgraduation in OB-GY, she completed her fetal medicine foundation accredited fellowship from Apollo center of fetal medicine, under Dr Anita Kaul. She trained from King’s College, London from Prof Kypros Nicolaides and Dr Vita Zidere (fetal echocardiography). She is Fetal Medicine foundation, UK certified for NT scan, anomaly scan, Dopplers, Cervical length, Pre-eclampsia screening, and Invasive procedures. She has also completed her fellowship in Medical Genetics from Sir Gangaram hospital, Delhi. She has more than 15 publications to her name including two in the ISUOG journal. She is a reviewer of many indexed journals. She is a faculty to the FOGSI-FMFi ultrasound course for the last 2 years. She has been a faculty-speaker at various national and international conferences.

Furcate and velamentous cord insertions are very rare. Furcate indicates forking of the cord vessels before it reaches the placental mass and, velamentous indicates insertion of cord into the membranes. This pictorial essay presents a case wherein both these entities were found together, diagnosed prenatally and confirmed postnatally.It briefs about the diagnostic features and its clinical implications.

Furcate insertion indicates the separation or forking of cord vessels before reaching the substance of placenta, and loss of the Wharton’s jelly. Furcate–velamentous cord insertion is rare and may predict potential complications like foetal growth restriction, preterm labour, antepartum haemorrhage, intrapartum rupture and haemorrhage, abnormal CTG patterns, abnormal Apgar scores and intrauterine foetal death (Figs. 1, 2).

Figure 1 (Left to right) Grayscale-colour Doppler and 4D-STIC CrystalVue Flow images of the prenatal ultrasound at 23 weeks show three-vessel umbilical cord inserting into the membranes over the anterior uterine wall (velamentous cord insertion) and at this point

Fig. 2 The same is confirmed in the post-partum specimen. Note that the forked vessels are bare, devoid of Wharton’s jelly as they course through the membranes (line arrows indicate the course of vessels through the membranes indicating velamentous insertion; open arrows indicate forking)

Acknowledgements I thank the obstetrician, for the post-partum picture of placenta and cord.there is forking of the umbilical vessels (arrow), known as furcate insertion (one artery and vein in one limb of the fork and another artery in another limb of the fork) before it finally reaches into the substance of placenta (lying posteriorly)

Declarations

Conflict of interest No conflict of interests.