What are the risks associated with a furcate placenta during pregnancy?

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Furcate Placenta Risks

A furcate placenta poses significant risk of catastrophic fetal hemorrhage from vessel rupture or avulsion during delivery, potentially leading to fetal death, and requires planned cesarean delivery with avoidance of cord traction. 1, 2

Primary Fetal Risks

Hemorrhage and Fetal Death

  • The most critical risk is sudden fetal hemorrhage from rupture or avulsion of unprotected umbilical vessels at the furcate insertion site, which can occur spontaneously during labor or from cord traction during placental delivery 3, 2
  • Hemorrhage from the umbilical vein at the furcate insertion can cause sudden intrauterine fetal death 3
  • One documented case required neonatal resuscitation and blood transfusion after spontaneous cord avulsion during delivery led to fetal hemorrhage 2

Structural Vulnerability

  • In furcate insertion, umbilical vessels separate from the cord substance and branch without the protective Wharton's jelly before inserting into the placenta, leaving vessels exposed and vulnerable to mechanical injury 3, 2
  • Pathological examination reveals fibrin deposition and focal infarction in the placental tissue beneath the furcate insertion site 3

Associated Complications

Fetal Growth Restriction

  • Small-for-gestational-age neonates have been documented with furcate insertion, though this may be confounded by other risk factors like maternal smoking 4

Placental Delivery Complications

  • Manual placental removal may be required, as attempted cord traction can result in vessel avulsion at the furcate insertion site 4

Clinical Management Implications

Prenatal Detection

  • Furcate insertion can be diagnosed prenatally through detailed color Doppler ultrasound showing umbilical vessels separating from the cord substance before placental insertion, even when the cord inserts centrally 3, 4
  • Most cases remain prenatally undiagnosed despite the availability of ultrasound detection 2

Delivery Planning

  • Cesarean delivery should be strongly considered to avoid the mechanical stress of vaginal delivery and potential vessel injury 4
  • If vaginal delivery occurs, cord traction must be completely avoided during third stage management to prevent vessel avulsion 4
  • Labor induction at 37 weeks has been performed in diagnosed cases to allow for controlled delivery timing 1

High-Risk Associations

  • Furcate insertion may coexist with placenta accreta spectrum, particularly in IVF pregnancies and women with Müllerian anomalies (such as unicornuate uterus), compounding maternal hemorrhage risk 5
  • Obstetricians should maintain heightened awareness for umbilical cord insertion abnormalities in pregnancies conceived through assisted reproductive technologies 5

Critical Pitfalls

  • The rarity of this condition (extremely rare) means most obstetricians lack experience with its management 3
  • Many cases have favorable outcomes despite being undiagnosed, which may lead to false reassurance about the condition's severity 2
  • The central placental insertion site in furcate insertion can create false reassurance, as the vessels still lack protective covering despite appearing normally positioned 3

References

1
Research

Prenatal Diagnosis of a Furcate Placenta.

Obstetrics and gynecology, 2020

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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