Kusakabe Hitomi, Miyamoto Taito, Yasuda Eriko, Komatsu Maya, Takakura Masahito, Yamaguchi Ayaka, Chigusa Yoshitsugu, Mandai Masaki, Mogami Haruta
Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, JPN.
Cureus. 2025 May 20;17(5):e84467. doi: 10.7759/cureus.84467. eCollection 2025 May.
The position of the umbilical cord within the uterus is influenced by its insertion site, with low insertion near the internal os raising concerns regarding the risk of cord prolapse and feasibility of vaginal delivery. This report describes a case of persistent cord presentation caused by marginal cord insertion at the lower edge of a low-lying placenta, further complicated by preterm premature rupture of membranes (pPROM) at 30 weeks. Given the fetal immaturity, expectant management was pursued despite the potential risk of cord prolapse. Although persistent amniotic fluid leakage occurred, no signs of fetal compromise or immediate cervical ripening were noted. Sequential transvaginal ultrasound examinations over a period of more than one month demonstrated a gradual resolution of cord presentation, likely facilitated by placental migration and descent of the fetal head shortly before the onset of labor. This progression ultimately enabled successful vaginal delivery at 35 weeks. The case reported herein highlights the critical role of close monitoring in managing persistent cord presentation associated with low cord insertion. Our findings suggest the possibility of avoiding cesarean delivery in similar high-risk scenarios.
脐带在子宫内的位置受其附着部位的影响，靠近宫颈内口的低附着会引发对脐带脱垂风险及阴道分娩可行性的担忧。本报告描述了一例因边缘性脐带附着于低置胎盘下缘导致的持续性脐带先露病例，该病例在孕30周时并发胎膜早破。鉴于胎儿不成熟，尽管存在脐带脱垂的潜在风险，但仍采取期待治疗。尽管持续有羊水渗漏，但未发现胎儿窘迫或宫颈即刻成熟的迹象。在一个多月的时间里进行的系列经阴道超声检查显示脐带先露逐渐缓解，这可能是由于胎盘迁移以及临产前胎头下降所致。这一进展最终使得孕35周时成功进行了阴道分娩。本文报告的病例突出了密切监测在处理与低脐带附着相关的持续性脐带先露中的关键作用。我们的研究结果表明，在类似的高风险情况下有可能避免剖宫产。
