Obligate Funic Presentation: A Case Report of Velamentous Cord Insertion in a Normally Implanted Placenta

Funic presentation refers to umbilical cord loops positioned between the presenting fetal part and the internal cervical os. While often transient, persistent positioning due to anatomic predisposition represents a high-risk variant, and potential precursor to cord prolapse. We report a case of a 39-year-old pregnant woman with a velamentous cord insertion in whom the umbilical cord remained persistently positioned over the cervical os, a presentation we term “obligate funic presentation”. The patient’s prenatal care was uncomplicated, and an ultrasound at 36 weeks identified umbilical cord loops over the internal os. She was admitted for close monitoring and subsequently developed regular preterm contractions with cervical change and recurrent variable decelerations that persisted despite resuscitative efforts. A cesarean delivery was performed at 36 weeks without evidence of cord prolapse at time of delivery. A healthy male infant was delivered that did not require NICU admission. Placental pathology revealed a marginal cord insertion. This case highlights obligate funic presentation occurring in the absence of placenta previa when the cord insertion is velamentous or marginal. Early recognition is critical, as this uncommon but high-risk condition may predispose to cord compression or prolapse, necessitating heightened surveillance and individualized delivery planning and patient counseling.